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1

Prolonged esophagitis after primary dysfunction of the pyloric sphincter in the rat and therapeutic potential of the gastric pentadecapeptide BPC 157.  

PubMed

Seven or fourteen days or twelve months after suturing one tube into the pyloric sphincter (removed by peristalsis by the seventh day), rats exhibit prolonged esophagitis with a constantly lowered pressure not only in the pyloric, but also in the lower esophageal sphincter and a failure of both sphincters. Throughout the esophagitis experiment, gastric pentadecapeptide BPC 157 (PL 14736) is given intraperitoneally once a day (10 microg/kg, 10 ng/kg, last application 24 h before assessment), or continuously in drinking water at 0.16 microg/ml, 0.16 ng/ml (12 ml/rat per day), or directly into the stomach 5 min before pressure assessment (a water manometer connected to the drainage port of a Foley catheter implanted into the stomach either through an esophageal or duodenal incision). This treatment alleviates i) the esophagitis (macroscopically and microscopically, at either region or interval), ii) the pressure in the pyloric sphincter, and iii) the pressure in the lower esophageal sphincter (cmH2O). In the normal rats it increases lower esophageal sphincter pressure, but decreases the pyloric sphincter pressure. Ranitidine, given using the same protocol (50 mg/kg, intraperitoneally, once daily; 0.83 mg/ml in drinking water; 50 mg/kg directly into the stomach) does not have an effect in either rats with esophagitis or in normal rats. PMID:17452811

Dobric, Ivan; Drvis, Petar; Petrovic, Igor; Shejbal, Drazen; Brcic, Luka; Blagaic, Alenka Boban; Batelja, Lovorka; Sever, Marko; Kokic, Neven; Tonkic, Ante; Zoricic, Ivan; Mise, Sandro; Staresinic, Mario; Radic, Bozo; Jakir, Ana; Babel, Jaksa; Ilic, Spomenko; Vuksic, Tihomir; Jelic, Ivan; Anic, Tomislav; Seiwerth, Sven; Sikiric, Predrag

2007-05-01

2

Sphincter of Oddi Dysfunction  

MedlinePLUS

... Buy IFFGD Merchandise Take Action Contact Us Donate Sphincter of Oddi Dysfunction The sphincter of Oddi is a muscular valve that controls the flow ... the first part of the small intestine (duodenum). Sphincter of Oddi dysfunction (SOD) describes the situation when the sphincter ...

3

Sphincter of Oddi dysfunction  

Microsoft Academic Search

Summary  Evidence continues to accumulate indicating that sphincter of Oddi dysfunction may give rise to cholestasis, pancreatitis,\\u000a or upper abdominal pain syndromes. Diagnosis of such dysfunction may be inferred from noninvasive tests or more precisely\\u000a defined by manometric studies. Both the biliary and pancreatic sphincters are commonly involved. If medical therapy is ineffective,\\u000a sphincter ablation via endoscopy or laparotomy should be

Glen A. Lehman; Stuart Sherman

1996-01-01

4

Motility of the pyloric sphincter studied by the inductograph method in conscious dogs.  

PubMed

The aim of the study is to evaluate the motility of the pyloric sphincter in conscious dogs by means of extraluminal transducers. For this purpose induction coils were chronically implanted in 12 dogs. After a meal the pylorus opened and closed in relation to the gastric waves. The mean changes in pyloric diameter were 5.4 +/- 1.0 mm. During phase I of the interdigestive state, the mean degree of pyloric opening was 39 +/- 18%. Gastric contractions occurring during phase II or phase III were accompanied with a marked increase in pyloric diameter; the degree of pyloric opening was 93 +/- 12%. Duodenal instillations of hydrochloric acid or oleic acid significantly diminished the pyloric diameter. Nutrients added to a viscous meal also diminished the pyloric opening significantly in comparison with an acaloric meal. Results suggest that the pyloric sphincter is involved in the control of gastric emptying. The inductograph is a useful technique to study pyloric activity without impediment of luminal flow in animals. PMID:3364566

Ehrlein, H J

1988-05-01

5

Six2 activity is required for the formation of the mammalian pyloric sphincter  

PubMed Central

The functional activity of Six2, a member of the so/Six family of homeodomain-containing transcription factors, is required during mammalian kidney organogenesis. We have now determined that Six2 activity is also necessary for the formation of the pyloric sphincter, the functional gate at the stomach-duodenum junction that inhibits duodenogastric reflux. Our data reveal that several genes known to be important for pyloric sphincter formation in the chick (e.g., Bmp4, Bmpr1b, Nkx2.5, Sox9, and Gremlin) also appear to be required for the formation of this structure in mammals. Thus, we propose that Six2 activity regulates this gene network during the genesis of the pyloric sphincter in the mouse.

Self, Michelle; Geng, Xin; Oliver, Guillermo

2009-01-01

6

Effect of arterial blood loss on myoelectrical activity of the pyloric sphincter and duodenum  

Microsoft Academic Search

Chronic experiments were carried out on six male rabbits weighing 2.6-3.2 kg. Two weeks before the experiment silver loop electrodes were implanted into the smooth muscles under the serous membrane of the pyloric sphincter and duodenum, by a method described previously [10, 11]. Electrical activity of the smooth muscles of the pyloroduodenal zone was recorded on an encephalograph at a

K. A. Shemerovskii

1990-01-01

7

Sphincter of Oddi dysfunction following liver transplantation  

Microsoft Academic Search

Although sphincter of Oddi dysfunction (SOD) has been extensively studied in the nontransplant setting, the diagnostic criteria after liver transplantation are not well defined and have been based on clinical features without manometric documentation. The purpose of this study was twofold: (1) to determine the manometric patterns associated with SOD following orthotopic liver transplantation (OLT) and (2) to define the

Viken Douzdjian; Michael M. Abecassis; Frederick C. Johlin

1994-01-01

8

Sphincter of Oddi dysfunction: an evidence-based review.  

PubMed

Sphincter of Oddi dysfunction is a painful syndrome that presents as recurrent episodes of right upper quadrant biliary pain, or recurrent idiopathic pancreatitis. It is a disease process that has been a subject of controversy, in part because its natural history, disease course and treatment outcomes have not been clearly defined in large controlled studies with long-term follow-up. This review is aimed at clarifying the state-of-the-art with an evidence-based summary of the current diagnostic and therapeutic approaches and modalities for sphincter of Oddi dysfunction. PMID:24161134

Rehman, Abdul; Affronti, John; Rao, Satish

2013-11-01

9

Pyloric gastrin-producing cells and pyloric sphincter muscle cells are nuclear targets for 3 H 1,25(OH) 2 vitamin D 3  

Microsoft Academic Search

Autoradiographic studies were conducted to identify and characterize target cells for 1,25(OH)2 vitamin D3 in the pyloric region of rats and mice. After injection of 3H 1,25(OH)2 vitamin D3, nuclear concentration of radioactivity was observed in nuclei of duodenal epithelium and certain cells of pyloric glands, while most of the epithelial cells in the pyloric and gastric glands did not

W. E. Stumpf; M. Sar; L. P. O'Brien; J. Morin

1988-01-01

10

Gallbladder ejection fraction and its relationship to sphincter of Oddi dysfunction  

Microsoft Academic Search

Theoretically, relative distal common bile duct obstruction due to sphincter of Oddi dysfunction may be a cause of poor gallbladder evacuation observed on quantitative cholescintigraphy. In this study, the relationship of sphincter of Oddi dysfunction to the gallbladder ejection fraction by quantitative cholescintigraphy was explored. Eighty-one patients with biliary-type pain and otherwise normal evaluations underwent quantitative cholescintigraphy, sphincter of Oddi

Thomas A. Ruffolo; Stuart Sherman; Glen A. Lehman; Robert H. Hawes

1994-01-01

11

Comparison of sphincter of Oddi manometry, fatty meal sonography, and hepatobiliary scintigraphy in the diagnosis of sphincter of Oddi dysfunction  

Microsoft Academic Search

Background: Sphincter of Oddi dysfunction (SOD) afflicts approximately 1% to 5% of patients after cholecystectomy. The diagnostic standard for SOD is sphincter of Oddi manometry (SOM), a technically difficult, invasive test that is frequently complicated by pancreatitis. A sensitive and accurate noninvasive imaging modality is thus needed for the diagnosis of SOD. Quantitative hepatobiliary scintigraphy (HBS) and fatty meal sonography

Mark L. Rosenblatt; Marc F. Catalano; Eduardo Alcocer; Joseph E. Geenen

2001-01-01

12

Intrasphincteric injection of botulinum toxin for suspected sphincter of Oddi dysfunction  

Microsoft Academic Search

Botulinum toxin is a potent inhibitor of the release of acetylcholine from nerve endings. It has previously been shown that it can effectively reduce lower oesophageal sphincter pressures both in animals and humans with achalasia. This study examined the hypothesis that locally injected botulinum toxin could also reduce sphincter of Oddi pressure in patients with sphincter of Oddi dysfunction. Two

P J Pasricha; E P Miskovsky; A N Kalloo

1994-01-01

13

Assessment of Lower Urinary Tract Dysfunction in Children with Non-Neuropathic Bladder Sphincter Dysfunction  

Microsoft Academic Search

Although nonneuropathic bladder sphincter dysfunction in children is frequently encountered, there is no consensus on the assessment of children presenting with this problem. An example is given of how these children can be assessed. After a noninvasive screening consisting of history, voiding diary, clinical examination, urinalysis, ultrasound and uroflowmetry, those children that will benefit from further videourodynamic studies are selected.

P. Hoebeke; J. Vande Walle; K. Everaert; E. Van Laecke; J. D. Van Gool

1999-01-01

14

Quantitative 99mTc-DISIDA scanning and endoscopic biliary manometry in sphincter of Oddi dysfunction  

Microsoft Academic Search

Sphincter of Oddi (SO) dysfunction is a recognised cause of postcholecystectomy pain, but a difficult condition to diagnose, requiring endoscopic biliary manometry (EBM) to confirm sphincter motor abnormalities. We have assessed quantitative cholescintigraphy in 10 postcholecystectomy (PC) patients with clinical and manometric evidence of SO dysfunction, 10 PC patients with non-biliary type abdominal pain and 10 asymptomatic PC volunteers acting

G M Fullarton; A Allan; T Hilditch; W R Murray

1988-01-01

15

Sphincter of Oddi dysfunction and unexplained abdominal pain: Clinical and manometric study  

Microsoft Academic Search

Unexplained, biliary-type abdominal pain is often attributed to an abnormal pressure profile of the sphincter of Oddi. In spite of this assumption, the true prevalence of this type of motor dysfunction among cholecystectomized patients with unexplained abdominal pain is not known. We studied 64 postcholecystectomy patients who were thought to have sphincter of Oddi dysfunction. Radiologically, other than a dilated

Hooshang Meshkinpour; Michael Mollot

1992-01-01

16

Sphincter of Oddi dysfunction in children with recurrent pancreatitis and anomalous pancreaticobiliary union: an etiologic concept  

Microsoft Academic Search

Background: The exact cause of recurrent pancreatitis among patients with anomalous pancreaticobiliary union is not known. Sphincter of Oddi dysfunction has been implicated as a mechanism. This study evaluated sphincter of Oddi function in children with anomalous pancreaticobiliary union and recurrent pancreatitis and assessed the results of endoscopic sphincterotomy in the management of this condition. Methods: We retrospectively reviewed 128

Moises Guelrud; Claudio Morera; Magaly Rodriguez; Domingo Jaen; Reinaldo Pierre

1999-01-01

17

Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction  

Microsoft Academic Search

Background & Aims: Patients with sphincter of Oddi dysfunction are at high risk of developing pancreatitis after endoscopic biliary sphincterotomy. Impaired pancreatic drainage caused by pancreatic sphincter hypertension is the likely explanation for this increased risk. A prospective, randomized controlled trial was conducted to determine if ductal drainage with pancreatic stenting protects against pancreatitis after biliary sphincterotomy in patients with

Paul R. Tarnasky; Yuko Y. Palesch; John T. Cunningham; Patrick D. Mauldin; Peter B. Cotton; Robert H. Hawes

1998-01-01

18

Bile duct crystals do not contribute to sphincter of Oddi dysfunction  

Microsoft Academic Search

Background: Microlithiasis has been proposed as a cause of both occult gallbladder disease and of idiopathic pancreatitis. Theoretically, microlithiasis could also cause postcholecystectomy pain by causing temporary biliary obstruction and may be more common in patients with sphincter of Oddi dysfunction. The frequency of crystals in bile duct aspirates was assessed from patients with symptoms after cholecystectomy with and without

Leonard G. Quallich; Mark A. Stern; Melissa Rich; William D. Chey; Jeffrey L. Barnett; Grace H. Elta

2002-01-01

19

Visceral Algesia in Irritable Bowel Syndrome, Fibromyalgia, and Sphincter of Oddi Dysfunction, Type III  

Microsoft Academic Search

Visceral hyperalgesia has been demonstrated inpatients with irritable bowel syndrome who are seen intertiary care centers. It has been hypothesized thatvisceral hyperalgesia may be related to psychological distress associated with health care seekingbehavior in these patients. Patients with fibromyalgiaand sphincter of Oddi dysfunction, type III, share manydemographic and psychosocial characteristics with patients with irritable bowel syndrome andprovide an opportunity to

Andrew Chun; Steven Desautels; Adam Slivka; Carlos Mitrani; Terence Starz; Carlo Dilorenzo; Arnold Wald

1999-01-01

20

Pelvic floor dysfunction 6 years post-anal sphincter tear at the time of vaginal delivery  

Microsoft Academic Search

Introduction and hypothesis  This study aims to estimate fecal, urinary incontinence, and sexual function 6 years after an obstetrical anal sphincter tear.\\u000a \\u000a \\u000a \\u000a Methods  Among 13,213 women who had a vaginal delivery of a cephalic singleton at term, 196 women sustained an anal sphincter tear.\\u000a They were matched to 588 controls. Validated questionnaires grading fecal and urinary incontinence, and sexual dysfunction\\u000a were completed

David Baud; Sylvain Meyer; Yvan Vial; Patrick Hohlfeld; Chahin Achtari

21

Bladder muscle biopsy and urethral sphincter EMG in patients with bladder dysfunction after pelvic surgery.  

PubMed Central

Eleven patients who suffered persistent bladder dysfunction after pelvic surgery have been investigated by needle urethral sphincter electromyography (EMG) and bladder muscle biopsy, and the results compared with those obtained in a series of controls. Individual motor units recorded from the urethral sphincter in patients who had undergone pelvic surgery were strikingly abnormal, suggesting the presence of reinnervation, and the density of detrusor innervation was significantly reduced. However, since reduction in the density of detrusor innervation may occur in circumstances other than peripheral nerve injury, we conclude that urethral sphincter EMG provides the most effective means of assessing damage to vesico-urethral innervation as a result of previous pelvic surgery. Images Figure 5.

Kirby, R S; Fowler, C J; Gilpin, S A; Gosling, J A; Milroy, E J; Turner-Warwick, R T

1986-01-01

22

Scintigraphy versus manometry in patients with suspected biliary sphincter of Oddi dysfunction  

PubMed Central

Introduction: Sphincter of Oddi (SO) manometry is at present the “gold standard” investigation for patients with suspected biliary SO dysfunction. Non-invasive scintigraphy in cholecystectomised patients using a complex scoring system or the transit time from the hepatic hilum to the duodenum (HDTT) have been promoted as sensitive and specific alternatives. Aim: To evaluate the scintigraphic scoring system and HDTT in patients with suspected biliary SO dysfunction undergoing SO manometry. Methods: Cholecystectomised patients undergoing SO manometry for persistent biliary-type pain, as defined by the Rome II criteria, for which all other causes had been excluded, were prospectively studied. Scintigraphy with cholecystokinin octapeptide infusion was performed within a month prior to manometry. Scoring of the scans and measurement of HDTT was performed by independent blinded observers. Manometry of the biliary sphincter was performed per-endoscopically and defined as abnormal if basal pressure was ? 40 mm Hg. Results: Thirty two patients were enrolled (30 females, mean age 45.1 years). Three patients were excluded from analysis because manometry from the bile duct was not technically possible. Eight patients had abnormal manometry. Scintigraphic scoring had a sensitivity of 25–38%, a specificity of 86–89%, positive predictive value (PPV) of 40–60%, and a negative predictive value (NPV) of 75–79%. The coefficient of variation for interobserver variation in scores was 0.72. HDTT sensitivity was 13%, specificity 95%, PPV 50%, and NPV 74%. Conclusions: Our findings indicate that scintigraphy using these methods of analysis correlates poorly with manometry in post cholecystectomy patients with suspected biliary SO dysfunction.

Craig, A G; Peter, D; Saccone, G T P; Ziesing, P; Wycherley, A; Toouli, J

2003-01-01

23

A laparoscopic transgastric approach to the treatment of sphincter of Oddi dysfunction postgastric bypass.  

PubMed

Obesity is endemic and bariatric surgery is increasing in an attempt to reduce the physiological and social cost. As the prevalence of bariatric surgery increases, in particular laparoscopic roux-en-Y gastric bypass (LRYGB), the need to investigate and treat subsequent pathology in the gastric remnant and biliary tree will accrue. We describe a novel combined surgical and endoscopic technique addressing the challenges of postoperative anatomy, allowing investigation and treatment of the gastric remnant and biliary tract. We present the case of a patient with sphincter of Oddi dysfunction post-LRYGB who underwent laparoscopic transgastric endoscopic injection of Botox into the ampulla with an excellent symptomatic relief. Subsequent laparoscopic transgastric sphincterotomy allowed definitive treatment and allowed symptom resolution at 6 months follow-up. Laparoscopic transgastric endoscopic investigation and treatment is a novel approach to circumvent the restrictions of post-LRYGB anatomy and may assume greater importance in an ageing obese population. PMID:23704421

Dickinson, Karen J; Beckett, Conrad G; May, John C; Halstead, James C

2013-01-01

24

Quantitative cholescintigraphy with fatty meal in the diagnosis of sphincter of Oddi dysfunction and acalculous cholecystopathy.  

PubMed

To evaluate the role of quantitative cholescintigraphy with fatty meal in the management of biliary dyskinesia and to describe the findings according to Sostre score (SS) criteria in patients with gallbladder (GB) in-situ and biliary pain. We performed a retrospective analysis of the hepatobiliary (HIDA) studies (n?=?35) performed for evaluation of biliary dyskinesia either due to biliary pain, opioid induced sphincter of Oddi dysfunction (SOD), recurrent pancreatitis (RP) or post cholecystectomy syndrome (PCS). Gallbladder ejection fraction (GBEF) was calculated from the post fatty meal HIDA images (excluding PCS patients). Studies with GBEF ?40 % and SS >4 were considered to have cholecystopathy and SOD respectively. Three of the 13 patients with PCS had SS of 6 each, suggestive of SOD. Delayed biliary visualization (>15 min) and activity in common bile duct 60 min?>?liver 15 min were the specific features in these cases. Opioid induced SOD patients had SS >4 with retrograde refilling of GB in one patient and normalization of the SS parameters after nifedipine challenge in the other patient. Patients with RP and biliary pain were stratified into four groups, normal (GBEF >40 % and SS ?4), cholecystopathy (GBEF ?40 % and SS ?4), normal with SOD (GBEF >40 % and SS >4) and cholecystopathy with SOD (GBEF ?40 % and SS >4). Four patients with intact GB had cholecystopathy with scintigraphic features of SOD. Quantitative cholescintigraphy with fatty meal and SS scoring identified biliary dyskinesia and SOD in patients with biliary pain, recurrent pancreatitis and post-cholecystectomy syndrome. PMID:22941730

Santhosh, Sampath; Mittal, Bhagwant Rai; Arun, Sasikumar; Sood, Ashwani; Bhattacharya, Anish; Kochhar, Rakesh

2012-07-01

25

Efficacy of nifedipine therapy in patients with sphincter of Oddi dysfunction: a prospective, double-blind, randomized, placebo-controlled, cross over trial.  

PubMed Central

1. Twenty-eight patients who fulfilled entry criteria for sphincter of Oddi dysfunction were randomly allocated to receive nifedipine and placebo in a cross over design with 12 week treatment periods separated by a 2 week wash-out. 2. All patients had episodic pain resembling biliary pain, had previously undergone cholecystectomy, had elevated alkaline phosphatase during episodes of pain and had elevated basal pressure on sphincter of Oddi manometry. 3. Compared with placebo, significant decreases in cumulative pain score, number of pain episodes, oral analgesic tablets consumed and emergency room visits were observed during nifedipine treatment. 4. Overall 21 patients improved during nifedipine therapy while seven patients did not. None of the following predicted response to nifedipine therapy: enzyme levels, morphine-Prostigmine test, fatty meal sonography, common duct diameter and pressure, sphincter of Oddi phasic pressure, frequency and duration of phasic waves and maximal fall in the basal pressure at sphincter of Oddi manometry after sublingual administration of nifedipine. However patients with predominant antegrade propagation of phasic contractions of sphincter of Oddi did significantly better on nifedipine than those with abnormal propagation of phasic contractions. 5. Nifedipine therapy orally in maximal tolerated doses relieves pain in patients with sphincter of Oddi dysfunction who have elevated basal pressure and sphincter of Oddi phasic contractions of predominantly antegrade nature.

Khuroo, M S; Zargar, S A; Yattoo, G N

1992-01-01

26

Prospective comparison of secretin-stimulated magnetic resonance cholangiopancreatography with manometry in the diagnosis of sphincter of Oddi dysfunction types II and III  

Microsoft Academic Search

Background: In sphincter of Oddi dysfunction (SOD), sphincter of Oddi manometry (SOM) predicts the response to sphincterotomy, but is invasive and associated with complications.Aim: To evaluate the role of secretin-stimulated magnetic resonance cholangiopancreatography (ss-MRCP) in predicting the results of SOM in patients with suspected type II or III SOD.Methods: MRCP was performed at baseline and at 1, 3, 5 and

Stephen P Pereira; Alice Gillams; Spiros N Sgouros; George J M Webster; Adrian R W Hatfield

2007-01-01

27

Manometry based randomised trial of endoscopic sphincterotomy for sphincter of Oddi dysfunction  

Microsoft Academic Search

BACKGROUNDEndoscopic sphincterotomy for biliary-type pain after cholecystectomy remains controversial despite evidence of efficacy in some patients with a high sphincter of Oddi (SO) basal pressure (SO stenosis).AIMTo evaluate the effects of sphincterotomy in patients randomised on the basis of results from endoscopic biliary manometry.METHODSEndoscopic biliary manometry was performed in 81 patients with biliary-type pain after cholecystectomy who had a dilated

J Toouli; I C Roberts-Thomson; J Kellow; J Dowsett; G T P Saccone; P Evans; P Jeans; M Cox; P Anderson; C Worthley; Y Chan; N Shanks; A Craig

2000-01-01

28

Human sphincter of oddi motility and cholecystokinin response following liver transplantation  

Microsoft Academic Search

The reported incidence of sphincter of Oddi dysfunction following orthotopic liver transplantation has ranged from 3% to 7%. If sphincteric dysfunction is unrecognized, therapy may be inappropriate; when recognized, extensive surgery may be required. To prospectively identify patients with sphincteric dysfunction, we performed sphincter of Oddi motility studies through the t-tube tract three months after transplantation. Baseline sphincter motility and

Robert D. Richards; Paul Yeaton; Hubert A. Shaffer; Daniel J. Pambianco; Timothy L. Pruett; William C. Stevenson; Ravinder K. Mittal; Richard W. McCallum

1993-01-01

29

Self-administered electroacupuncture provides symptomatic relief in a patient with sphincter of Oddi dysfunction: a patient's report.  

PubMed

A 46-year-old woman with differentially diagnosed sphincter of Oddi dysfunction (SOD) type III is described. After two and a half years of managing the condition with a conventional medical/pharmacological approach, the patient's symptoms worsened and she sought complementary approaches, starting traditional acupuncture treatment before receiving training from a practitioner of Western medical acupuncture to self-administer electroacupuncture. The frequency and intensity of severe night-time pain attacks reduced and, additionally, self-administered manual acupuncture during pain attacks resulted in quick, lasting, complete symptomatic pain resolution. This is the first published case report using electroacupuncture in the clinical management of this condition. It shows patient-administered electroacupuncture as a low-risk well-tolerated procedure which provided effective pain relief and reduced the frequency and severity of pain attacks. Self-administered acupuncture could be considered as a potential complementary medical approach for patients with SOD type III before resorting to endoscopic SO manometry and sphincterotomy which carry significant associated risks of pancreatitis. PMID:24008012

Walter, Wolfgang Andreas; Curtis, Hazel Clare

2013-12-01

30

Videofluoroscopy-Guided Balloon Dilatation for the Opening Dysfunction of Upper Esophageal Sphincter by Postoperative Vagus Nerve Injury: A Report on Two Cases  

PubMed Central

Dysphagia secondary to peripheral cranial nerve injury originates from weak and uncoordinated contraction-relaxation of cricopharyngeal muscle. We report on two patients who suffered vagus nerve injury during surgery and showed sudden dysphagia by opening dysfunction of upper esophageal sphincter (UES). Videofluoroscopy-guided balloon dilatation of UES was performed. We confirmed an early improvement of the opening dysfunctions of UES, although other neurologic symptoms persisted. While we did not have a proper comparison of cases, the videofluoroscopy-guided balloon dilatation of UES is thought to be helpful for the early recovery of dysphagia caused by postoperative vagus nerve injury.

Jung, Bora; Choi, Ikjun; Lee, Nam Jae; Jung, Kwang-Ik; Yoo, Woo-Kyoung

2014-01-01

31

BPC 157 therapy to detriment sphincters failure-esophagitis-pancreatitis in rat and acute pancreatitis patients low sphincters pressure.  

PubMed

Possibly, acute esophagitis and pancreatitis cause each other, and we focused on sphincteric failure as the common causative key able to induce either esophagitis and acute pancreatitis or both of them, and thereby investigate the presence of a common therapy nominator. This may be an anti-ulcer pentadecapeptide BPC 157 (tested for inflammatory bowel disease, wound treatment) affecting esophagitis, lower esophageal and pyloric sphincters failure and acute pancreatitis (10 ?g/kg, 10 ng/kg intraperitoneally or in drinking water). The esophagitis-sphincter failure procedure (i.e., insertion of the tubes into the sphincters, lower esophageal and pyloric) and acute pancreatitis procedure (i.e., bile duct ligation) were combined in rats. Esophageal manometry was done in acute pancreatitis patients. In rats acute pancreatitis procedure produced also esophagitis and both sphincter failure, decreased pressure 24 h post-surgery. Furthermore, bile duct ligation alone immediately declines the pressure in both sphincters. Vice versa, the esophagitis-sphincter failure procedure alone produced acute pancreatitis. What's more, these lesions (esophagitis, sphincter failure, acute pancreatitis when combined) aggravate each other (tubes into sphincters and ligated bile duct). Counteraction occurred by BPC 157 therapies. In acute pancreatitis patients lower pressure at rest was in both esophageal sphincters in acute pancreatitis patients. We conclude that BPC 157 could cure esophagitis/sphincter/acute pancreatitis healing failure. PMID:22204800

Petrovic, I; Dobric, I; Drmic, D; Sever, M; Klicek, R; Radic, B; Brcic, L; Kolenc, D; Zlatar, M; Kunjko, K; Jurcic, D; Martinac, M; Rasic, Z; Boban Blagaic, A; Romic, Z; Seiwerth, S; Sikiric, P

2011-10-01

32

Use of vector volume manometry and endoanal magnetic resonance imaging in the adult female for assessment of anal sphincter dysfunction  

Microsoft Academic Search

PURPOSE: This study compared conventional water-perfused and vector volume anal manometry in female patients with neurogenic fecal incontinence and chronic anal fissure and in healthy female volunteers. We used endoanal magnetic resonance (MR) imaging to measure internal and external sphincter lengths and thicknesses and contrasted these with the manometric findings in the different anorectal conditions. METHODS: One hundred thirty-three female

Andrew P. Zbar; Witold A. Kmiot; Mohammed Aslam; Andreanna Williams; Amy Hider; Riccardo A. Audisio; Antonio Chiappa; Nandita deSouza

1999-01-01

33

HYPERTROPHIC PYLORIC STENOSIS  

PubMed Central

Hypertrophic pyloric stenosis, a relatively common condition, is caused by hyperplasia of the musculature of the pylorus. The diagnosis is made by a history of projectile vomiting and failure to gain weight, the observation of gastric peristaltic waves, and the palpation of a pyloric “tumor.” A method of palpating this tumor is described in detail. Roentgenological studies are rarely indicated. Pylorotomy for treatment of hypertrophic pyloric stenosis was not successful until the development of necessary supporting measures. Preparation for operation consists of intravenous administration of fluids and electrolytes and sometimes serum or whole blood. The position of the tumor governs the choice between two different incisions. The operative procedure herein described is essentially that devised by Ramstedt many years ago, with modifications to facilitate the procedure.

Gans, Stephen L.

1959-01-01

34

Prospective comparison of secretin-stimulated magnetic resonance cholangiopancreatography with manometry in the diagnosis of sphincter of Oddi dysfunction types II and III  

PubMed Central

Background In sphincter of Oddi dysfunction (SOD), sphincter of Oddi manometry (SOM) predicts the response to sphincterotomy, but is invasive and associated with complications. Aim To evaluate the role of secretin?stimulated magnetic resonance cholangiopancreatography (ss?MRCP) in predicting the results of SOM in patients with suspected type II or III SOD. Methods MRCP was performed at baseline and at 1, 3, 5 and 7?min after intravenous secretin. SOD was diagnosed when the mean basal sphincter pressure at SOM was >40?mm Hg. Long?term outcome after SOM, with or without endoscopic sphincterotomy, was assessed using an 11?point (0–10) Likert scale. Results Of 47 patients (male/female 9/38; mean age 46?years; range 27–69?years) referred for SOM, 27 (57%) had SOD and underwent biliary and/or pancreatic sphincterotomy. ss?MRCP was abnormal in 10/16 (63%) type II and 0/11 type III SOD cases. The diagnostic accuracy of ss?MRCP for SOD types II and III was 73% and 46%, respectively. During a mean follow?up of 31.6 (range 17–44)?months, patients with normal SOM and SOD type II experienced a significant reduction in symptoms (mean Likert score 8 vs 4; p?=?0.03, and 9 vs 1.6; p?=?0.0002, respectively), whereas in patients with SOD type III, there was no improvement in pain scores. All patients with SOD and an abnormal ss?MRCP (n?=?12) reported long?term symptom improvement (mean Likert score 9.2 v 1.2, p<0.001). Conclusions ss?MRCP is insensitive in predicting abnormal manometry in patients with suspected type III SOD, but is useful in selecting patients with suspected SOD II who are most likely to benefit from endotherapy.

Pereira, Stephen P; Gillams, Alice; Sgouros, Spiros N; Webster, George J M; Hatfield, Adrian R W

2007-01-01

35

Epidermolysis bullosa and congenital pyloric atresia.  

PubMed

The association between epidermolysis bullosa (EB) and pyloric atresia (PA) is rare but well documented. Herein, we report a case of EB associated with congenital PA. A female baby, weighing 1480 g, was born vaginally to a 31-year-old gravida 7 lady at 33 weeks of gestation. Polyhydramnios was detected on antenatal assessment. The parents were non-consanguineous Saudis with no family history of significant illness. At birth, well-demarcated areas of peeled skin were present over knees, left leg and periumbilical region. Systemic examination revealed no other abnormality. On second day, the patient developed recurrent vomiting and abdominal distension. An abdominal X-ray revealed a single gastric gas bubble suggesting pyloric obstruction. Following gastroduodenostomy, the baby developed severe sepsis with multiorgan dysfunction and expired on 25th day of life. Skin biopsy showed cleavage within lamina lucida. PMID:24068383

Mithwani, Anwar Adil; Hashmi, Asif; Adil, Salman

2013-01-01

36

Reproducibility of endoscopic sphincter of Oddi manometry  

Microsoft Academic Search

Results from endoscopic sphincter of Oddi manometry are being used to support the diagnosis of sphincter dysfunction in patients with unexplained pain after cholecystectomy. However, there are few data on the reproducibility of manometric records or motility diagnosis during a second test. In this study, the reproducibility of manometric records was assessed in 12 patients with pain after cholecystectomy by

A. Thune; J. Scicchitano; I. Roberts-Thomson; J. Toouli

1991-01-01

37

Sphincter of oddi (pancreatic) hypertension and recurrent pancreatitis  

Microsoft Academic Search

Major papilla pancreatic sphincter dysfunction, a variant of sphincter of Oddi dysfunction, causes pancreatitis and pancreatic-type\\u000a pain. The gold standard for diagnosis is sphincter of Oddi manometry, most commonly performed at endoscopic retrograde cholangiopancreatography\\u000a (ERCP). Noninvasive testing, such as secretin-stimulated transabdominal or endoscopic ultrasound assessment of pancreatic\\u000a duct diameter, is less reliable and has relatively low sensitivity. Two thirds of

Benedict M. Devereaux; Stuart Sherman; Glen A. Lehman

2002-01-01

38

Pyloric stenosis in a foal.  

PubMed

A two month old Thoroughbred filly was presented with signs of depression, grinding of the teeth, frothing of the mouth and abdominal pain. These signs had persisted for two weeks despite treatment with mineral oil, dioctyl sodium sulfosuccinate, meperidine and antibiotics. A variety of diagnostic tests were done, the only abnormal finding was a stress leukon. On exploratory laparotomy the stomach was dilated with fluid and gas and the pyloric canal was constricted. Pyloroplasty resulted in correction of the condition. The etiological possibilities are discussed. This is believed to be the first report of pyloric stenosis in the horse. PMID:7427855

Barth, A D; Barber, S M; McKenzie, N T

1980-08-01

39

Effect of octreotide on sphincter of oddi motility in patients with acute recurrent pancreatitis  

Microsoft Academic Search

Sphincter of Oddi dysfunction has been reported as a cause of acute idiopathic recurrent pancreatitis (IRP). Octreotide, a long-acting somatostatin analogue, is an antisecretory drug used in the treatment and prevention of acute pancreatitis. Its action on sphincter of Oddi motility is controversial and no data are available for IRP patients. The aim of this study was to assess sphincter

Vincenzo Di Francesco; Giampaolo Angelini; Paolo Bovo; Maria Beatrice Casarini; Marco Filippini; Bruna Vaona; Luca Frulloni; Laura Rigo; Maria Paola Brunori; Giorgio Cavallini

1996-01-01

40

Electrophysiology of motor pathways for sphincter control in multiple sclerosis.  

PubMed

The central and peripheral motor pathways serving striated sphincter muscle function were studied using cortical and lumbar transcutaneous electrical stimulation, pudendal nerve stimulation and sphincter electromyography in 23 patients with multiple sclerosis (MS), and sphincter disturbance, including incontinence of urine or faeces, urinary voiding dysfunction, or constipation. The central motor conduction time was significantly increased in the MS group compared to controls (p less than 0.05). Damage to both the upper and lower motor neuron pathways can contribute to sphincter disturbance in MS. The latter may be due to coexisting pathology or to involvement of the conus medullaris by MS. PMID:2178181

Mathers, S E; Ingram, D A; Swash, M

1990-11-01

41

Functional Gallbladder and Sphincter of Oddi Disorders  

Microsoft Academic Search

The functional disorder of the gallbladder (GB) is a motility disorder caused initially either by metabolic abnormalities or by a primary motility alteration. The functional disorders of the sphincter of Oddi (SO) encompass motor abnormal- ities of either the biliary or the pancreatic SO. Dysfunction of the GB and\\/or biliary SO produce similar patterns of pain. The pain caused by

JOSE BEHAR; ENRICO CORAZZIARI; MOISES GUELRUD; WALTER HOGAN; STUART SHERMAN; JAMES TOOULI

42

Urinary bladder-urethral sphincter dysfunction in mice with targeted disruption of neuronal nitric oxide synthase models idiopathic voiding disorders in humans.  

PubMed

Idiopathic voiding disorders affect up to 10-15% of men and women. We describe bladder abnormalities in mice with targeted deletion of the gene for neuronal nitric oxide synthase which model the clinical disorders. The mice possess hypertrophic dilated bladders and dysfunctional urinary outlets which do not relax in response to electrical field stimulation or L-arginine. The mice also display increased urinary frequency. PMID:9142130

Burnett, A L; Calvin, D C; Chamness, S L; Liu, J X; Nelson, R J; Klein, S L; Dawson, V L; Dawson, T M; Snyder, S H

1997-05-01

43

Internal anal sphincter augmentation and substitution.  

PubMed

There is an increasing recognition of the importance of internal anal sphincter (IAS) dysfunction presenting as passive faecal incontinence. This problem may manifest after anal sphincterotomy or following the more minimally invasive operations for haemorrhoids, as well as with advancing age. Because of the poor results of IAS plication and the beneficial outcomes with peri-urethral bulking agents in urology, these materials have been developed for use in IAS dysfunction. This review outlines the basic purported mechanisms of action, defining the materials in clinical use, their methods of deployment, complications and reported outcomes. There is still much that is unknown concerning the ideal agent or the volume and the technique of deployment, which will only be answered by powerful, prospective, randomized, controlled trials. The specific role of autologous stem cells designed to regenerate the sphincters in cases of functional impairment or muscle loss is yet to be seen. PMID:24759338

de la Portilla, Fernando

2014-05-01

44

Internal anal sphincter augmentation and substitution  

PubMed Central

There is an increasing recognition of the importance of internal anal sphincter (IAS) dysfunction presenting as passive faecal incontinence. This problem may manifest after anal sphincterotomy or following the more minimally invasive operations for haemorrhoids, as well as with advancing age. Because of the poor results of IAS plication and the beneficial outcomes with peri-urethral bulking agents in urology, these materials have been developed for use in IAS dysfunction. This review outlines the basic purported mechanisms of action, defining the materials in clinical use, their methods of deployment, complications and reported outcomes. There is still much that is unknown concerning the ideal agent or the volume and the technique of deployment, which will only be answered by powerful, prospective, randomized, controlled trials. The specific role of autologous stem cells designed to regenerate the sphincters in cases of functional impairment or muscle loss is yet to be seen.

de la Portilla, Fernando

2014-01-01

45

Relation of pyloric motility to pyloric opening and closure in healthy subjects.  

PubMed Central

The relation between pyloric motor activity, opening, and closure was examined in eight healthy men. Manometry was performed with an assembly combining 13 side holes and a sleeve sensor positioned astride the pylorus. Simultaneous with manometry, pyloric opening and closure and antroduodenal contractions were observed fluoroscopically with the antrum filled with barium. During intraduodenal normal saline infusion, coordinated antral pressure waves swept over the pylorus and ejected barium into the duodenum. No localised pyloric motor pattern was observed under these conditions. In contrast, the intraduodenal triglyceride infusion was associated with the absence of antral pressure waves and virtual absence of antral wall movement. At the pylorus, there was a zone of luminal occlusion less than 1 cm long that persisted for the period of observation. This zone of luminal occlusion corresponded precisely with manometric recordings of a narrow zone of pyloric phasic and tonic activity. During the duodenal triglyceride infusion, the pylorus was closed for 98.5% of the measurement period when basal pyloric pressure was 4 mm Hg or more, and during this motor pattern, barium did not traverse the pylorus. Localised pyloric contractions cause sustained pyloric closure, whether these contractions are phasic or tonic. These contractions occur independently of antral or duodenal contractions and may interrupt gastric emptying. Images Figure 3 Figure 4 Figure 5

Tougas, G; Anvari, M; Dent, J; Somers, S; Richards, D; Stevenson, G W

1992-01-01

46

Endoscopic approach to the patient with motility disorders of the bile duct and sphincter of Oddi.  

PubMed

Since its original description by Oddi in 1887, the sphincter of Oddi has been the subject of much study. Furthermore, the clinical syndrome of sphincter of Oddi dysfunction (SOD) and its therapy are controversial areas. Nevertheless, SOD is commonly diagnosed and treated by physicians. This article reviews the epidemiology, clinical manifestations, and current diagnostic and therapeutic modalities of SOD. PMID:23540967

Leung, Wesley D; Sherman, Stuart

2013-04-01

47

[Treatment of sphincter insufficiency].  

PubMed

Surgical therapy of anal sphincter insufficiency is only indicated if it leads to symptoms and conservative treatment fails to achieve adequate symptom relief. Various new surgical options have evolved over the last decade but evidence of the efficacy varies substantially. Some have gained broader clinical acceptance based on the efficacy, ease of applicability and low risk profile. The paper aims to outline the currently commonly accepted and frequently applied surgical techniques for the treatment of anal sphincter insufficiency and the results, put these into the context of a treatment algorithm and to present novel techniques which carry potential for the future. PMID:23292153

Matzel, K E; Bittorf, B

2013-01-01

48

Vaginal delivery is associated with occult disruption of the anal sphincter mechanism.  

PubMed

Childbirth is thought to be an important cause of pelvic floor dysfunction. Heretofore, this has been thought due to pudendal denervation. Endovaginal sonography allows thorough assessment of the anorectum and in this study was used to assess nulliparous women and women before and after delivery. Two groups were studied. Thirty-two nulliparous subjects without complaints of incontinence were studied once. Thirty-four pregnant women were studied before and after delivery. Endovaginal sonography was used to assess integrity of internal and external anal sphincters, thickness of the levator bundle, internal and external sphincters, anal length, and the angle between the levator bundles. Delivery was associated with disruption of the internal and external sphincters. No nulliparous women (nonpregnant or pregnant) had sphincter disruption demonstrated. Episiotomy in the index delivery was associated with increased thickness in the external sphincter and a smaller angle between the levator bundles. Vaginal delivery is associated with occult disruption of the anal sphincters. PMID:9394161

Sandridge, D A; Thorp, J M; Roddenberry, P; Kuller, J; Wild, J

1997-10-01

49

Effect of propofol on human sphincter of Oddi  

Microsoft Academic Search

The effect of propofol was studied in 11 patients who had common bile duct sphincter of Oddi manometry for suspected dysfunction. Patients were initially sedated with midazolam and then further or resedated with propofol for the second set of pressure measurements. Recordings were made about 10 min after giving each drug. No patient had elevated basal pressure initially. Average basal

John S. Goff

1995-01-01

50

Plasma Lipids, Genetic Variants near APOA1, and the Risk of Infantile Hypertrophic Pyloric Stenosis  

PubMed Central

Importance Infantile Hypertrophic Pyloric Stenosis (IHPS) is a serious condition in which hypertrophy of the pyloric sphincter muscle layer leads to gastric outlet obstruction. IHPS shows strong familial aggregation and heritability, but knowledge about specific genetic risk variants is limited. Objective To search the genome comprehensively for genetic associations with IHPS and validate findings in three independent sample sets. Design, Setting, and Participants In stage 1, we used reference data from the 1000 Genomes Project for imputation into a genome-wide dataset of 1001 Danish surgery-confirmed cases (diagnosed between 1987–2008) and 2371 disease-free controls. In stage 2, the five most significantly associated loci were tested in independent case-control sample sets from Denmark (cases diagnosed between 1983–2010), Sweden (cases diagnosed between 1958–2011), and the United States (cases diagnosed between 1998–2005) with a total of 1663 cases and 2315 controls. Main Outcome Measure Presence of Infantile Hypertrophic Pyloric Stenosis Results We found a new genomewide significant locus for IHPS at chromosome 11q23.3. The most significant SNP at the locus, rs12721025 (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.38–1.83, P = 1.9×10?10), is located 301 bases downstream of the Apolipoprotein A-I (APOA1) gene and is correlated (r2 between 0.46 and 0.80) with SNPs previously found to be associated with levels of circulating cholesterol. For these SNPs, the cholesterol lowering allele consistently conferred increased risk of IHPS. Conclusions and Relevance We have identified a new genomewide significant locus for IHPS. Characteristics of this locus suggest the possibility of an inverse relationship between levels of circulating cholesterol in neonates and IHPS risk which warrants further investigation.

Feenstra, Bjarke; Geller, Frank; Carstensen, Lisbeth; Romitti, Paul A.; Korberg, Izabella Baranowska; Bedell, Bruce; Krogh, Camilla; Fan, Ruzong; Svenningsson, Anna; Caggana, Michele; Nordenskjold, Agneta; Mills, James L.; Murray, Jeffrey C.; Melbye, Mads

2014-01-01

51

Obstetric anal sphincter lacerations  

Microsoft Academic Search

OBJECTIVE:To estimate the frequency of obstetric anal sphincter laceration and to identify characteristics associated with this complication, including modifiable risk factors.METHODS:A population-based, retrospective study of over 2 million vaginal deliveries at California hospitals was performed, using information from birth certificates and discharge summaries for 1992 through 1997. We excluded preterm births, stillbirths, breech deliveries, and multiple gestations. The main outcome

Victoria L Handa; Beate H Danielsen; William M Gilbert

2001-01-01

52

An experimental model of prolonged esophagitis with sphincter failure in the rat and the therapeutic potential of gastric pentadecapeptide BPC 157.  

PubMed

We report a simple novel rat model that combines prolonged esophagitis and parallel sphincters failure. The anti-ulcer gastric pentadecapeptide BPC 157, which was found to be stable in gastric juice, and is being evaluated in inflammatory bowel disease trials, is an anti-esophagitis therapy that recovers failed sphincters. Twelve or twenty months after the initial challenge (tubes sutured into sphincters for one week and then spontaneously removed by peristalsis), rats exhibit prolonged esophagitis (confluent hemorrhagic and yellowish lesions, thinner epithelium and superficial corneal layer, with stratification derangement); constantly lowered pressure of both sphincters (assessed by using a water manometer connected to the drainage port of a Foley catheter implanted into the stomach either through esophageal or duodenal incision); and both lower esophageal and pyloric sphincter failure. Throughout the esophagitis experiment, BPC 157 was given at either 10 micro g/kg, i.p., once a day (last application 24 h before assessment) or alternatively, it was given continuously in drinking water at 0.16 micro g/ml (12 ml/rat). This treatment recovers i) esophagitis (macroscopically and microscopically, at either region or investigated time period) and ii) pressure in both sphincters (cmH2O). In addition, BPC 157 (10 micro g/kg) or saline (1 ml/rat, 5 ml/kg) was specifically given directly into the stomach; pressure assessment was performed at 5 min thereafter. The effect of BPC 157 is specific because in normal rats, it increases lower esophageal sphincter-pressure, but decreases pyloric sphincter-pressure. Ranitidine, given as the standard drug using the same protocol (50 mg/kg, i.p., once daily; 0.83 mg/ml in drinking water; or 50 mg/kg directly into the stomach) had no effect. PMID:17116974

Petrovic, Igor; Dobric, Ivan; Drvis, Petar; Shejbal, Drazen; Brcic, Luka; Blagaic, Alenka Boban; Batelja, Lovorka; Kokic, Neven; Tonkic, Ante; Mise, Stjepan; Baotic, Tomislav; Staresinic, Mario; Radic, Bozo; Jakir, Ana; Vuksic, Tihomir; Anic, Tomislav; Seiwerth, Sven; Sikiric, Predrag

2006-11-01

53

Comparison of Ultrasound-Secretin Test and Sphincter of Oddi Manometry in Patients with Recurrent Acute Pancreatitis  

Microsoft Academic Search

Manometry is considered the gold standard forevaluating sphincter of Oddi dysfunction. It hasrecently been demonstrated that the ultrasound (US)secretin test proposed a few years ago as a noninvasive test for the study of sphincter of Oddidysfunction yields a substantial percentage ofpathological findings in patients with acute recurrentpancreatitis. The aim of this study was to compare theresults of the US secretin

V. Di Francesco; M. P. Brunori; L. Rigo; J. Toouli; G. Angelini; L. Frulloni; P. Bovo; M. Filippini; B. Vaona; G. Talamini; G. Cavallini

1999-01-01

54

Identification of groupers based on pyloric caeca differentiation.  

PubMed

The examination of nine species of groupers present in south-east Indian waters has indicated that the pyloric caeca number, pattern and colouration are reliable and useful characters for identification. Three distinct morphotypes of pyloric caeca were observed in this study. PMID:22026609

Roy, T S C; Gopalakrishnan, A

2011-11-01

55

Pyloric atresia associated with duodenal and jejunal atresia and duplication.  

PubMed

A case of congenital pyloric atresia associated with duodenal atresia, jejunal atresia, and a duplication is described. A review of the literature revealed nine previously reported cases of congenital pyloric atresia and multiple intestinal atresias, but this is the first report of such an association and a duplication. PMID:10525913

Al-Salem, A H

1999-01-01

56

Standards for anal sphincter replacement  

Microsoft Academic Search

PURPOSE: Anal sphincter replacement offers a new treatment option for patients with severe refractory fecal incontinence or for those who require abdominoperineal resection for localized malignancy. The purpose of this study was to review the current status of anal sphincter replacement, formulate a consensus statement regarding its current use, and outline suggestions for future development. METHODS: Four areas of interests

Robert D. Madoff; Cornelius G. M. I. Baeten; John Christiansen; Harald R. Rosen; Norman S. Williams; John A. Heine; Paul A. Lehur; Ann C. Lowry; David Z. Lubowski; Klaus E. Matzel; R. J. Nicholls; Massimo Seccia; Alan G. Thorson; Steven D. Wexner; W. Douglas Wong

2000-01-01

57

Quantification of dynamic velopharyngeal port excursion following sphincter pharyngoplasty.  

PubMed

The sphincter pharyngoplasty is a surgical procedure designed to correct velopharyngeal dysfunction. Its advocates cite the theoretical advantage of its induction of dynamic activity of the neovelopharyngeal port, but this dynamic activity has yet to be quantitatively demonstrated in the literature. The purpose of this study was to quantify postoperative velopharyngeal dynamism and to document the results of intervention outcome on sphincteric excursion measurements from minimal-to-maximal orifice closure. We conducted a 7-year retrospective review of speech videofluoroscopy evaluations in patients who had undergone sphincter pharyngoplasty in our center. Between 1989 and 1994, there were 58 patients so treated for postpalatoplasty velopharyngeal dysfunction by two surgeons using the same operative technique. Patients for whom sphincter pharyngoplasty was recommended fulfilled both of the following criteria: (1) velopharyngeal dysfunction caused by an anatomic, myoneural, or combined deficiency of the velopharyngeal sphincter that would not be expected to be managed by speech therapy alone, and (2) preoperative videonasendoscopy and speech videofluoroscopic studies that demonstrated large-gap coronal, circular, or bow-tie closure patterns or velopharyngeal hypodynamism. Of the original 58 patients, 24 underwent postoperative speech videofluoroscopic evaluations with basal views. Of these, 20 of the evaluations (83 percent) were of adequate quality to be included in a research study. Still images showing maximum and minimum excursion of the sphincter in basal view were obtained. To test for observer reliability, the speech videofluoroscopic studies were randomized and presented for measurement to the same individual on two occasions, each session separated by a 1-month time interval. Topographic imaging software was used to obtain maximum and minimum measurements to within 0.1 mm. Partitioning the variance of the data showed that measurement variability was a very small portion of the total, and that difference between the minimum and maximum values was the largest source of variability. Of the total variability in the data, 64.0 percent originated in the minimum/maximum difference, 34.3 percent came from patient variability, and only 1.7 percent resulted from original or repeat measurements. The patient variability may be exaggerated because of variability in the scale of measurement. Results of this study indicate a quantifiable and statistically significant difference in maximum-to-minimum excursion of sphincteric closure. Sphincter pharyngoplasty appears to be dynamic in the majority of cases. PMID:9529202

Witt, P D; Marsh, J L; Arlis, H; Grames, L M; Ellis, R A; Pilgram, T K

1998-04-01

58

Advances in infantile hypertrophic pyloric stenosis.  

PubMed

Infantile hypertrophic pyloric stenosis (IHPS) is a common condition in infancy, characterized by an acquired narrowing of the pylorus, which requires surgery. These infants usually present with projectile, nonbilious vomiting, with a palpable 'olive' in the abdomen and sometimes a 'peristaltic wave' after being fed with formula or breast milk. Although IHPS is a common disorder, its etiology is largely unknown. Surgical intervention is the standard treatment, preoperative preparation, however is essential to optimal outcome. In this review, the latest advances in IHPS regarding epidemiology, etiology, diagnostics and treatment will be discussed. PMID:24716658

Peters, Babette; Oomen, Mathijs Wn; Bakx, Roel; Benninga, Marc A

2014-07-01

59

Factors associated with infantile hypertrophic pyloric stenosis.  

PubMed

We examined perinatal factors in relation to the rise in incidence of infantile hypertrophic pyloric stenosis among children in Olmsted County, Minnesota, during the period from 1950 through 1984. Primogeniture was associated with male infants but not female infants; some factor related to primogeniture, such as breast-feeding, may be etiologically important. Our data did not support a role for maternal disease, use of doxylamine succinate-pyridoxide hydrochloride (Bendectin), or an infectious process. Further study should be directed toward environmental factors associated with primogeniture. PMID:3344722

Jedd, M B; Melton, L J; Griffin, M R; Kaufman, B; Hoffman, A D; Broughton, D; O'Brien, P C

1988-03-01

60

Genetics Home Reference: Epidermolysis bullosa with pyloric atresia  

MedlinePLUS

Epidermolysis bullosa with pyloric atresia Related Gene(s) References Quick links to this topic MedlinePlus Health information Genetic and Rare Diseases Information Center Information about genetic conditions and rare diseases Additional NIH ...

61

New insights into the pathogenesis of infantile pyloric stenosis  

Microsoft Academic Search

Infantile hypertrophic pyloric stenosis (IHPS) is the most common surgical cause of vomiting in infants. Despite numerous\\u000a hypotheses, the aetiopathogenesis of IHPS is not fully understood. Genetic, extrinsic and hormonal factors have been implicated\\u000a in the pathogenesis of the disease. Furthermore, abnormalities of various components of the pyloric muscle such as smooth\\u000a muscle cells, growth factors, extracellular matrix elements, nerve

Christina Panteli

2009-01-01

62

Secretin MRCP and endoscopic pancreatic manometry in the evaluation of sphincter of Oddi function: a comparative pilot study in patients with idiopathic recurrent pancreatitis  

Microsoft Academic Search

BackgroundSphincter of Oddi dysfunction plays an important etiologic role in idiopathic acute recurrent pancreatitis. Sphincter of Oddi manometry is the most accurate test of sphincter of Oddi function, but it is associated with an increased risk of post-procedure pancreatitis and is non-diagnostic in about a third of cases. Secretin MRCP has a diagnostic efficacy comparable to ERCP, but data on

Alberto Mariani; Simona Curioni; Alessandro Zanello; Sandro Passaretti; Enzo Masci; Marzia Rossi; Alessandro Del Maschio; Pier Alberto Testoni

2003-01-01

63

Physiological and Functional Evaluation of the Transposed Human Pylorus as a Distal Sphincter  

PubMed Central

Background/Aims Studies evaluating the human pylorus as a sphincter are scanty and contradictory. Recently, we have shown technical feasibility of transposing the human pylorus for end-stage fecal incontinence. This unique cohort of patients provided us an opportunity to study the sphincter properties of the pylorus in its ectopic position. Methods Antro-pylorus transposition on end sigmoid colostomies (n = 3) and in the perineum (n = 15) was performed for various indications. Antro-pylorus was assessed functionally (digital examination, high resolution spatiotemporal manometry, barium retention studies and colonoscopy) and by imaging (doppler ultrasound, MRI and CT angiography) in its ectopic position. Results The median resting pressure of pylorus on colostomy was 30 mmHg (range 28-38). In benign group, median resting pressure in perineum was 12.5 mmHg (range 6-44) that increased to 21.5 mmHg (range 12-29) (P = 0.481) and 31 mmHg (range 16-77) (P = 0.034) on first and second follow-up, respectively. In malignant group, median post-operative pressures were 20 mmHg (range 14-36) and 21 mmHg (range 18-44) on first and second follow-up, respectively. A definite tone and gripping sensation were felt in all the patients on digital examination. On distal loopogram, performed through the diverting colostomies, barium was retained proximal to the neo-pyloric valve. Both perineal ultrasound and MRI showed viable transposed graft. CT angiography and color doppler studies confirmed vascular flow in the transposed position. Conclusions The human pyloric valve can function as a tonic sphincter when removed from the gastroduodenal continuity.

Ghoshal, Uday C; Gupta, Vishal; Jauhari, Ramendra; Srivastava, Rajendra N; Misra, Asha; Kumar, Ashok; Kumar, Manoj

2012-01-01

64

Pyloric Gland Adenoma in Lynch Syndrome  

PubMed Central

The prevalence of gastric cancer associated with Lynch syndrome (LS) is highly variable, and the underlying histologic pathway or molecular mechanisms remain unclear. From 1995 to 2012, 15 patients had been treated for both gastric and colonic adenocarcinomas and diagnosed as LS. In all cases, pathologic review, immunohistochemical analysis for mismatch-repair proteins, and microsatellite instability (MSI) tests were performed. To confirm LS, germline mutation tests and multiplex ligation-dependent probe amplification were performed. All gastric and colonic carcinomas were MSI-high and lost expressions of MLH1/PMS2 in 11 (73%) cases and MSH2/MSH6 in 4 (27%) cases. Remarkably, in a patient with LS and germline mutation of MLH1 gene, pyloric gland adenoma (PGA) transformed to adenocarcinoma during follow-up. In 2 additional cases, PGA was found adjacent to advanced gastric cancers. All PGAs in LS patients were MSI-high and lost expression of mismatch-repair proteins (MLH1/PMS2 in 2 cases and MSH2/MSH6 in 1 case), whereas none of the 14 sporadic PGAs was MSI-high or had lost expression of mismatch-repair proteins. On the basis of these observations, although very rare, we suggest the possibility that PGA may be a precursor lesion to gastric adenocarcinoma in LS and that the mismatch-repair deficient pathway of carcinogenesis is involved early in the gastric carcinogenesis pathway.

Lee, Seung Eun; Kang, So Young; Cho, Junhun; Lee, Boram; Chang, Dong Kyung; Woo, Hyein; Kim, Jong Won; Park, Ha Young; Do, In Gu; Kim, Young Eun; Kushima, Ryoji; Lauwers, Gregory Y.; Park, Cheol Keun

2014-01-01

65

Riddle of the sphincters in anal fissure  

Microsoft Academic Search

To the Editor The pathogenesis of anal fissure is not yet fully clear. Essential to the development of a chronic anal fissure is a vicious circle with the factors of inflammatory infiltrate, pain, and sphincter hypertonicity. One cannot safely say whether the sphincteric tone is primarily increased or whether the contraction of the sphincter is because of the intense pain.

Wolfgang H. Jost; Klaus Schimrigk; Horst Mlitz

1995-01-01

66

Cholescintigraphic detection of functional obstruction of the sphincter of Oddi. Effect of papillotomy  

SciTech Connect

Unexplained abdominal pain after cholecystectomy has been attributed to sphincter of Oddi dysfunction, but no objective diagnostic criteria exist. Biliary excretion was quantitated by computer-assisted cholescintigraphy in 35 postcholecystectomy controls without symptoms, 9 patients with suspected sphincter of Oddi dysfunction (studied before and after sphincterotomy), and 18 patients with overt cholestasis from other causes (6 with extrahepatic obstruction and 12 with parenchymal liver disease). In patients with sphincter of Oddi dysfunction or with cholestasis, the time to attain maximal activity in the biliary system was significantly (p less than 0.05) longer, the percent of radiotracer excreted at 45, 60, and 90 min was less, and the emptying rate was slower compared with the controls. Cholecystokinin (0.02 U/kg X min) did not abolish biliary output, excluding a paradoxical response of the sphincter. After sphincterotomy, biliary activity peaked earlier and the percent excreted at 45 min increased but did not revert to normal. Relief of symptoms occurred in 8 of 9 patients. The one failure had normal emptying characteristics before sphincterotomy, and did not change after surgery. Another developed recurrent pain and a corresponding deterioration in biliary emptying on serial scans. Thus, functional obstruction at the sphincter of Oddi exists, is not due to any paradoxical response to cholecystokinin, and in the absence of overt cholestasis, can be detected by quantitative cholescintigraphy. Successful sphincterotomy may not completely restore biliary emptying to normal.

Shaffer, E.A.; Hershfield, N.B.; Logan, K.; Kloiber, R.

1986-03-01

67

Penile agenesis and congenital hypertrophic pyloric stenosis: an association or a random coexistence?  

PubMed

A neonate with penile agenesis and congenital hypertrophic pyloric stenosis is presented. The patterns of associated anomalies with penile agenesis, and those of congenital hypertrophic pyloric stenosis are discussed. PMID:15368696

Yagmurlu, Aydin; Vargun, Rahsan; Gollu, Gulnur; Gokcora, I Haluk

2004-01-01

68

Penile agenesis and congenital hypertrophic pyloric stenosis: An association or a random coexistence?  

Microsoft Academic Search

A neonate with penile agenesis and congenital hypertrophic pyloric stenosis is presented. The patterns of associated anomalies\\u000a with penile agenesis, and those of congenital hypertrophic pyloric stenosis are discussed.

Aydin Yagmurlu; Rahsan Vargun; Gulnur Gollu; I. Haluk Gokcora

2004-01-01

69

Organization of electrical activity in the canine pyloric canal.  

PubMed Central

1. The electrical activity of the canine gastroduodenal junction was investigated using cross-sectional muscle preparations and intracellular recording techniques. 2. Spontaneous electrical slow waves were recorded from antral and pyloric cells but not from duodenal cells adjacent to the pyloric region. Slow waves were generated in the antrum and propagated to the pyloric region via the circular layer. Pyloric slow waves consisted of an upstroke phase, a plateau phase and oscillations superimposed upon the plateau, whereas antral slow waves had smooth plateau potentials. 3. Within the pylorus slow waves decayed in amplitude with distance from the myenteric border of the circular muscle; the majority of pyloric circular cells were normally electrically quiescent. 4. The longitudinal muscle in the pylorus was electrically coupled and paced by the circular muscle. In longitudinal cells slow waves were usually of long duration with multiple spikes superimposed upon the plateau phase. 5. Nifedipine (10(-8) to 10(-5) M) decreased slow waves amplitude and duration. Tetraethylammonium ions (TEA; 10 mM) increased the duration of slow waves, caused spiking activity during the plateau phase and also elicited spiking in the quiescent regions. 6. The results suggest that gastric slow waves pace the myenteric portion of the circular muscle layer and the longitudinal layer of the pylorus, but do not traverse the gastroduodenal junction, nor pace the majority of cells within the circular muscle of the pylorus. Other excitatory mechanisms are necessary to activate these regions and to co-ordinate their motility with gastric motility.

Sanders, K M; Vogalis, F

1989-01-01

70

Pyloric atresia associated with epidermolysis bullosa--three cases presenting in three months.  

PubMed

Three neonates presenting with pyloric atresia and epidermolysis bullosa are described in this report. Two babies underwent surgery for pyloric atresia, and 1 of these has survived until 3 months of age with no complications. The clinical presentation and complications of the pyloric atresia-epidermolysis bullosa syndrome are discussed with a brief review of literature. PMID:15300543

Samad, Lubna; Siddiqui, Eram Faiza; Arain, Mohammad Anwar; Atif, Mohammad; Parkash, Jai; Ahmed, Soofia; Ibrahim, Siddiqua; Jan, Iftikhar Ahmed

2004-08-01

71

Gastric versus post-pyloric feeding: a systematic review  

PubMed Central

Background Our objective was to evaluate the impact of gastric versus post-pyloric feeding on the incidence of pneumonia, caloric intake, intensive care unit (ICU) length of stay (LOS), and mortality in critically ill and injured ICU patients. Method Data sources were Medline, Embase, Healthstar, citation review of relevant primary and review articles, personal files, and contact with expert informants. From 122 articles screened, nine were identified as prospective randomized controlled trials (including a total of 522 patients) that compared gastric with post-pyloric feeding, and were included for data extraction. Descriptive and outcomes data were extracted from the papers by the two reviewers independently. Main outcome measures were the incidence of nosocomial pneumonia, average caloric goal achieved, average daily caloric intake, time to the initiation of tube feeds, time to goal, ICU LOS, and mortality. The meta-analysis was performed using the random effects model. Results Only medical, neurosurgical and trauma patents were enrolled in the studies analyzed. There were no significant differences in the incidence of pneumonia, percentage of caloric goal achieved, mean total caloric intake, ICU LOS, or mortality between gastric and post-pyloric feeding groups. The time to initiation of enteral nutrition was significantly less in those patients randomized to gastric feeding. However, time to reach caloric goal did not differ between groups. Conclusion In this meta-analysis we were unable to demonstrate a clinical benefit from post-pyloric versus gastric tube feeding in a mixed group of critically ill patients, including medical, neurosurgical, and trauma ICU patients. The incidences of pneumonia, ICU LOS, and mortality were similar between groups. Because of the delay in achieving post-pyloric intubation, gastric feeding was initiated significantly sooner than was post-pyloric feeding. The present study, while providing the best current evidence regarding routes of enteral nutrition, is limited by the small total sample size.

Marik, Paul E; Zaloga, Gary P

2003-01-01

72

Botulinum A toxin as a treatment of detrusor- sphincter dyssynergia in patients with spinal cord injury: MRI controlled transperineal injections  

Microsoft Academic Search

OBJECTIVESTo correlate clinical and urodynamic findings with MRI in patients with spinal cord injury and detrusor-sphincter dyssynergia who were consecutively treated with transperineal injections of botulinum-A toxin (BTX-A) under EMG control.METHODSSix patients with spinal cord injury and upper motor neuron bladder dysfunction associated with detrusor- sphincter dyssynergia were prospectively analysed. One hundred international units (IU) BTX-A (Botox® in 1 ml

Brigitte Schurch; Juerg Hodler; Bilijana Rodic

1997-01-01

73

Recent results of treatment of infantile hypertrophic pyloric stenosis.  

PubMed Central

During the five year period December 1980 to November 1985, 106 infants with hypertrophic pyloric stenosis were treated. There were no operative deaths, but two late deaths occurred from associated abnormalities. The combination of preoperative rehydration, skilled anaesthesia, and the use of the Fredet-Ramstedt operation (pyloromyotomy) have virtually eliminated mortality from uncomplicated infantile hypertrophic pyloric stenosis. The most common complications were gastro-oesophageal reflux in 11 (11%), perforation of the duodenal fornix in nine (8%), and wound infection in five (5%); no wound dehisced.

Zeidan, B; Wyatt, J; Mackersie, A; Brereton, R J

1988-01-01

74

Postcholecystectomy Pain Syndrome: Pathophysiology of Abdominal Pain in Sphincter of Oddi Type III  

Microsoft Academic Search

Background & Aims: Persistent abdominal pain occurs in many patients after cholecystectomy, some of whom are described as having sphincter of Oddi dysfunction (SOD). Pain in SOD type III is thought to be of biliary origin with little objective data, and treatment is often unsatisfactory. Chronic abdominal pain without a bio- logical disease marker is similar to irritable bowel syndrome,

STEVEN G. DESAUTELS; ADAM SLIVKA; WILLIAM R. HUTSON; ANDREW CHUN; CARLOS MITRANI; CARLO DILORENZO; ARNOLD WALD

1999-01-01

75

Management of detrusor external sphincter dyssynergia in neurogenic bladder.  

PubMed

Spinal cord injury (SCI) affects 11.5 to 53.4 individuals per million of the population in developed countries each year. SCI is caused by trauma, although it can also result from myelopathy, myelitis, vascular disease or arteriovenous malformations and multiple sclerosis. Patients with complete lesions of the spinal cord between spinal cord level T6 and S2, after they recover from spinal shock, generally exhibit involuntary bladder contractions without sensation, smooth sphincter synergy, but with detrusor striated sphincter dyssynergia (DESD). Those with lesions above spinal cord level T6 may experience, in addition, smooth sphincter dyssynergia and autonomic hyperreflexia. DESD is a debilitating problem in patients with SCI. It carries a high risk of complications, and even life expectancy can be affected. Nearly half of the patients with untreated DESD will develop deleterious urologic complications, due to high intravesical pressures, resulting in urolithiasis, urinary tract infection (UTI), vesicoureteral reflux (VUR), hydronephrosis, obstructive uropathy, and renal failure. The mainstay of treatment is the use of antimuscarinics and catheterization, but in those for whom this is not possible external sphincterotomy has been a last resort option. External sphincterotomy is associated with significant risks, including haemorrhage; erectile dysfunction and the possibility of redo procedures. Over the last decade alternatives have been investigated, such as urethral stents and intrasphincteric botulinum toxin injection. In this review, we will cover neurogenic DESD, with emphasis on definition, classifications, diagnosis and different therapeutic options available. PMID:22081065

Mahfouz, W; Corcos, J

2011-12-01

76

Vagal afferent innervation of the lower esophageal sphincter.  

PubMed

To supply a fuller morphological characterization of the vagal afferents innervating the lower esophageal sphincter (LES), specifically to label vagal terminals in the tissues forming the LES in the gastroesophageal junction, the present experiment employed injections of dextran biotin into the nodose ganglia of rats. Four types of vagal afferents innervated the LES. Clasp and sling muscle fibers were directly and prominently innervated by intramuscular arrays (IMAs). Individual IMA terminals subtended about 16° of arc of the esophageal circumference, and, collectively, the terminal fields were distributed within the muscle ring to establish a 360° annulus of mechanoreceptors in the sphincter wall. 3D morphometry of the terminals established that, compared to sling muscle IMAs, clasp muscle IMAs had more extensive arbors and larger receptive fields. In addition, at the cardia, local myenteric ganglia between smooth muscle sheets and striated muscle bundles were innervated by intraganglionic laminar endings (IGLEs), in a pattern similar to the innervation of the myenteric plexus throughout the stomach and esophagus. Finally, as previously described, the principle bundle of sling muscle fibers that links LES sphincter tissue to the antropyloric region of the lesser curvature was innervated by exceptionally long IMAs as well as by unique web ending specializations at the distal attachment of the bundle. Overall, the specialized varieties of densely distributed vagal afferents innervating the LES underscore the conclusion that these sensory projections are critically involved in generating LES reflexes and may be promising targets for managing esophageal dysfunctions. PMID:23583280

Powley, Terry L; Baronowsky, Elizabeth A; Gilbert, Jared M; Hudson, Cherie N; Martin, Felecia N; Mason, Jacqueline K; McAdams, Jennifer L; Phillips, Robert J

2013-10-01

77

Velopharyngeal Dysfunction  

PubMed Central

Velopharyngeal dysfunction (VPD) is a generic term which describes a set of disorders resulting in the leakage of air into the nasal passages during speech production. As a result, speech samples can demonstrate hypernasality, nasal emissions, and poor intelligibility. The finding of VPD can be secondary to several causes: anatomic, musculoneuronal, or behavioral/mislearning. To identify the etiology of VPD, patients must undergo a thorough velopharyngeal assessment comprised of perceptual speech evaluation and functional imaging, including video nasendoscopy and speech videofluoroscopy. These studies are then evaluated by a multidisciplinary team of specialists, who can decide on an optimal course for patient management. A treatment plan is developed and may include speech therapy, use of a prosthetic device, and/or surgical intervention. Different surgical options are discussed, including posterior pharyngeal flap, sphincter pharyngoplasty, Furlow palatoplasty, palatal re-repair, and posterior pharyngeal wall augmentation.

Woo, Albert S.

2012-01-01

78

LIM homeodomain transcription factor Isl1 directs normal pyloric development by targeting Gata3  

PubMed Central

Background Abnormalities in pyloric development or in contractile function of the pylorus cause reflux of duodenal contents into the stomach and increase the risk of gastric metaplasia and cancer. Abnormalities of the pyloric region are also linked to congenital defects such as the relatively common neonatal hypertrophic pyloric stenosis, and primary duodenogastric reflux. Therefore, understanding pyloric development is of great clinical relevance. Here, we investigated the role of the LIM homeodomain transcription factor Isl1 in pyloric development. Results Examination of Isl1 expression in developing mouse stomach by immunohistochemistry, whole mount in situ hybridization and real-time quantitative PCR demonstrated that Isl1 is highly expressed in developing mouse stomach, principally in the smooth muscle layer of the pylorus. Isl1 expression was also examined by immunofluorescence in human hypertrophic pyloric stenosis where the majority of smooth muscle cells were found to express Isl1. Isl1 function in embryonic stomach development was investigated utilizing a tamoxifen-inducible Isl1 knockout mouse model. Isl1 deficiency led to nearly complete absence of the pyloric outer longitudinal muscle layer at embryonic day 18.5, which is consistent with Gata3 null mouse phenotype. Chromatin immunoprecipitation, luciferase assays, and electrophoretic mobility shift assays revealed that Isl1 ensures normal pyloric development by directly targeting Gata3. Conclusions This study demonstrates that the Isl1-Gata3 transcription regulatory axis is essential for normal pyloric development. These findings are highly clinically relevant and may help to better understand pathways leading to pyloric disease.

2014-01-01

79

External Urethral Sphincter Pressure Measurement: An Accurate Method for the Diagnosis of Detrusor External Sphincter Dyssynergia?  

PubMed Central

Background Combined pelvic floor electromyography (EMG) and videocystourethrography (VCUG) during urodynamic investigation are the most acceptable and widely agreed methods for diagnosing detrusor external sphincter dyssynergia (DESD). Theoretically, external urethral sphincter pressure (EUSP) measurement would provide enough information for the diagnosis of DESD and could simplify the urodynamic investigation replacing combined pelvic floor EMG and VCUG. Thus, we evaluated the diagnostic accuracy of EUSP measurement for DESD. Patients & Methods A consecutive series of 72 patients (36 women, 36 men) with neurogenic lower urinary tract dysfunction able to void spontaneously was prospectively evaluated at a single university spinal cord injury center. Diagnosis of DESD using EUSP measurement (index test) versus combined pelvic floor EMG and VCUG (reference standard) was assessed according to the recommendations of the Standards for Reporting of Diagnostic Accuracy Initiative. Results Using EUSP measurement (index test) and combined pelvic floor EMG and VCUR (reference standard), DESD was diagnosed in 10 (14%) and in 41 (57%) patients, respectively. More than half of the patients presented discordant diagnosis between the index test and the reference standard. Among 41 patients with DESD diagnosed by combined pelvic floor EMG and VCUR, EUSP measurement identified only 6 patients. EUSP measurement had a sensitivity of 15% (95% CI 5%–25%), specificity of 87% (95% CI 76%–98%), positive predictive value of 60% (95% CI 30%–90%), and negative predictive value of 56% (95% CI 44%–68%) for the diagnosis of DESD. Conclusions For diagnosis of DESD, EUSP measurement is inaccurate and cannot replace combined pelvic floor EMG and VCUR.

Gregorini, Flavia; Birnbock, Dorothee; Kozomara, Marko; Mehnert, Ulrich; Kessler, Thomas M.

2012-01-01

80

Results with sphincter pharyngoplasty and pharyngeal flap  

Microsoft Academic Search

Objective: To evaluate speech outcomes and complications of sphincter pharyngoplasty and pharyngeal flap performed for management of velopharyngeal insufficiency (VPI). Design: Case series. Setting: Tertiary care children’s hospital. Patients: All patients who underwent pharyngeal flap or sphincter pharyngoplasty from 1990 to 1995. Methods: Perceptual speech analysis was used to assess severity of VPI, presence of nasal air emissions and quality

Lianne M. de Serres; Frederic W.-B. Deleyiannis; Linda E. Eblen; Joseph S. Gruss; Mark A. Richardson; Kathleen C. Y. Sie

1999-01-01

81

Cesarean delivery and anal sphincter injury  

Microsoft Academic Search

Objective: Cesarean delivery has been thought to prevent all obstetric anal sphincter damage. The objective of this study was to determine the relationship between the timing of cesarean during primiparous delivery and injury to the anal sphincter mechanism.Methods: A prospective observational study was conducted, using a continence questionnaire and anorectal physiology assessment before and six weeks after primiparous delivery. A

Michelle Fynes; Valerie S Donnelly; P. Ronan O’Connell; Colm O’Herlihy

1998-01-01

82

Strangulated perforated hiatus hernia due to pyloric stenosis.  

PubMed

The first patient with strangulated hiatus hernia due to pyloric stenosis is reported. A 70-year-old male patient presented as an emergency with severe left-sided chest pain, tachycardia, tachypnea, dysphagia, and nausea but no vomiting. The diagnosis of strangulated hiatus hernia due to pyloric stenosis was suspected, because a CT scan done 24 h following a barium meal showed much retained barium in both infra- and supradiaphragmatic parts of the stomach. Recognition of this condition is important since absence of pneumoperitoneum should not delay the diagnosis. In this complication, the perforation is likely to be at the hiatus, not the fundus as occurs in other causes of strangulation. A gastric drainage procedure should be an essential part of treatment. PMID:21706334

Naraynsingh, Vijay; Maharaj, Ravi; Dan, Dilip; Hariharan, Seetharaman

2013-04-01

83

The role of the upper oesophageal sphincter in voice rehabilitation after laryngectomy and Staffieri's procedure.  

PubMed

The Staffieri method was used for voice rehabilitation after total laryngectomy in our patients. Leakage of saliva has been a problem in some. It has been suggested that aspiration could be due to specific pressure relations in the pharynx, upper oesophageal sphincter and cervical oesophagus during deglutition (Mann et al., 1980). Regarding voice production, the upper oesophageal sphincter is probably the main sound source, functioning in essentially the same way as in oesophageal speech. Intraluminal pressure recordings at rest and during swallowing were used in 16 Staffieri speakers and 9 oesophageal speakers. Upper oesophageal sphincter dysfunction was seen more often in Staffieri speakers with aspiration problems than in Staffieri speakers without aspiration problems, but the relation is not clearly understood. A definite relation could be established between upper oesophageal sphincter function in terms of relaxation and coordination and aerodynamic pressure measured in the tracheostoma, necessary to sustain phonation. After dilatation of the oesophagus, produced by the inflow of air, a reflex rise in the upper oesophageal sphincter pressure is thought to occur. The pressure necessary to sustain phonation probably depends on the extent to which this reflex mechanism occurs and on the ability of the patient to induce a relaxation of the upper oesophageal sphincter before air expulsion. Selective myotomy will possibly lower the necessary pressure and enhance vocal rehabilitation. Whether this will solve a part of the aspiration problems in Staffieri speakers is completely unpredictable, as the relation of the motor function of the upper oesophageal sphincter and the aspiration problems is not well understood. PMID:3944505

Vuyk, H D; Klinkenberg-Knol, E; Tiwari, R M

1986-01-01

84

Infantile hypertrophic pyloric stenosis after prenatal exposure to thalidomide  

Microsoft Academic Search

In a retrospective study of 832 cases of thalidomide embryopathy (ThE) between October 1, 1959 and July 31, 1962, a highly significant accumulation of cases with infantile hypertrophic pyloric stenosis (IHPS) was registrated. Clinical course, X-ray and surgical findings and the sex ratio (male preponderance) were identical to IHPS occurring spontaneously. In the order of frequency of defects in ThE,

K. H. Schäfer; M. Kramer

1987-01-01

85

Plectin Gene Mutations Can Cause Epidermolysis Bullosa with Pyloric Atresia  

Microsoft Academic Search

Epidermolysis bullosa with pyloric atresia (EB-PA), manifesting with neonatal blistering and gastric anomalies, is known to be caused by mutations in the hemidesmosomal genes ITGA6 and ITGB4, which encode the ?6 and ?4 integrin polypeptides, respectively. As part of our molecular diagnostics program, we have now encountered four families with EB-PA in which no mutations could be identified in these

Ellen Pfendner; Jouni Uitto

2005-01-01

86

A Rare Association of Pyloric Stenosis and Situs Inversus: Impact on Diagnosis and Treatment  

PubMed Central

A rare case of 23 days old boy is reported having congenital hypertrophic pyloric stenosis with situs inversus. Incidentally detected secondary diagnosis obscured the primary diagnosis by altering the physical examination findings. Diagnosis was made by ultrasonography (USG) which revealed congenital hypertrophic pyloric stenosis with situs inversus. Clinical details, diagnosis and management are discussed.

Gupta, Anil Kumar; Yadav, Lokesh; Pathak, Manish

2014-01-01

87

Sphincter of oddi manometry in healthy volunteers  

Microsoft Academic Search

In this study we describe in detail the characteristics of sphincter of Oddi motor function in a large group of healthy subjects. Studies were obtained in 50 healthy volunteers. The findings showed a sphincter of Oddi segment that had a basal pressure of 14.8±6.3 mm Hg (X±sd). Phasic contractions were superimposed on the basal pressure. They had an amplitude of

Moises Guelrud; Sonia Mendoza; Guillermo Rossiter; Maria I. Villegas

1990-01-01

88

Infantile hypertrophic pyloric stenosis: where should it be treated?  

PubMed Central

A retrospective analysis in the form of an audit into the management of infantile hypertrophic pyloric stenosis in a district general hospital has revealed that the results are equivalent to that of published data from specialised units. It is stressed in this study that close co-operation has to be maintained between paediatricians and surgeons in the care of these infants. The diagnosis can be made on clinical grounds in the majority of cases. The operation has to be carried out by experienced surgeons and anaesthetists. The morbidity can be minimised under these circumstances and pyloromyotomy can be performed safely in a district general hospital.

Jahangiri, M.; Osborne, M. J.; Jayatunga, A. P.; Bradley, J. W.; Mitchenere, P.

1993-01-01

89

Simultaneous penile prosthesis and male sling/artificial urinary sphincter  

PubMed Central

Erectile dysfunction (ED) and stress urinary incontinence (SUI) from urethral sphincteric deficiency is not an uncommon problem. The commonest etiology is intervention for localized prostate cancer and/or radical cystoprostatectomy for muscle invasive bladder cancer. Despite advances in surgical technology with robotic assisted laparoscopic prostatectomy and nerve sparing techniques, the rates of ED and SUI remain relatively unchanged. They both impact greatly on quality of life domains and have been associated with poor performance outcomes. Both the artificial urinary sphincter and penile prosthesis are gold standard treatments with proven efficacy, satisfaction and durability for end-stage SUI and ED respectively. Simultaneous prosthesis implantation for concurrent conditions has been well described, mostly in small retrospective series. The uptake of combination surgery has been slow due in part to technical demands of the surgery and to an extent, a heightened anxiety over potential complications. This paper aims to discuss the technical aspect of concurrent surgery for both disease entity and the current published outcomes of the various surgical techniques with this approach.

Lee, Dominic; Romero, Claudio; Alba, Frances; Westney, O Lenaine; Wang, Run

2013-01-01

90

Infantile hypertrophic pyloric stenosis in Belfast, 1957-1969.  

PubMed Central

Infants with hypertrophic pyloric stenosis born in Belfast during the 13 years 1957-1969 have been reviewed. Their distribution shows a bias towards higher social classes, breast feeding, and primogeniture. Obstetric factors and parental ages seem to be of no importance. More affected infants were born during winter months than would be expected. The overall incidence of infantile pyloric stenosis in this community has fallen during the period under review. Clinically, the patients started vomiting at a mean age of 22 days and it is recommended that the condition should not be called 'congenital'. The size of the tumour is mainly determined by the size of the patient, rather than by his age or duration of symptoms. Attention is drawn to the occurrence of haematemesis in 17-5% and melaena in 2-9% of infants. Jaundice occurred in 1-8% of patients in this series, and is attributed to the adverse effect of starvation on hepatic glucuronyl transferase activity. Other conditions noted in these patients included inguinal hernia, partial thoracic stomach, and phenylketonuria. Subsequent growth and development were in the anticipated range.

Dodge, J A

1975-01-01

91

Infantile hypertrophic pyloric stenosis in Belfast, 1957-1969.  

PubMed

Infants with hypertrophic pyloric stenosis born in Belfast during the 13 years 1957-1969 have been reviewed. Their distribution shows a bias towards higher social classes, breast feeding, and primogeniture. Obstetric factors and parental ages seem to be of no importance. More affected infants were born during winter months than would be expected. The overall incidence of infantile pyloric stenosis in this community has fallen during the period under review. Clinically, the patients started vomiting at a mean age of 22 days and it is recommended that the condition should not be called 'congenital'. The size of the tumour is mainly determined by the size of the patient, rather than by his age or duration of symptoms. Attention is drawn to the occurrence of haematemesis in 17-5% and melaena in 2-9% of infants. Jaundice occurred in 1-8% of patients in this series, and is attributed to the adverse effect of starvation on hepatic glucuronyl transferase activity. Other conditions noted in these patients included inguinal hernia, partial thoracic stomach, and phenylketonuria. Subsequent growth and development were in the anticipated range. PMID:1170811

Dodge, J A

1975-03-01

92

Management of cricopharyngeus muscle dysfunction.  

PubMed

The cricopharyngeus muscle (CPM) is a key component of the upper esophageal sphincter (UES). In dysphagia, cricopharyngeus muscle dysfunction (CPD) refers to the muscle's failure to appropriately and completely relax or expand during deglutition. A variety of disease processes may cause CPD, and the resultant clinical manifestation is solid food or solid and liquid dysphagia. Several diagnostic tools are available for dysphagia clinicians to distinguish CPD from other causes of UES dysfunction. For CPD, accurate diagnosis is paramount for the recommendation of appropriate treatment. In appropriately selected patients, intervention at the CPM may yield significant improvement in dysphagia. PMID:24262961

Kuhn, Maggie A; Belafsky, Peter C

2013-12-01

93

Negative exploration for pyloric stenosis - Is it preventable?  

PubMed Central

Background The diagnosis of infantile hypertrophic pyloric stenosis (IHPS), although traditionally clinical, is now increasingly dependent on radiological corroboration. The rate of negative exploration in IHPS has been reported as 4%. The purpose of our study was to look at elements of supportive clinical evidence leading to positive diagnosis, and to review these with respect to misdiagnosed cases undergoing negative exploration. Methods All infants undergoing surgical exploration for IHPS between January 2000 and December 2004 were retrospectively analysed with regard to clinical symptoms, examination findings, investigations and operative findings. Results During the study period, 343 explorations were performed with a presumptive diagnosis of IHPS. Of these, 205 infants (60%) had a positive test feed, 269 (78%) had a positive ultrasound scan and 175 (55%) were alkalotic (pH ?7.45 and/or base excess ?2.5). The positive predictive value for an ultrasound (US) diagnosis was 99.1% for canal length ?14 mm, and 98.7% for muscle thickness ?4 mm. Four infants (1.1%) underwent a negative surgical exploration; Ultrasound was positive in 3, and negative in 1(who underwent surgery on the basis of a positive upper GI contrast). One US reported as positive had a muscle thickness <4 mm. Two false positive US were performed at peripheral hospitals. One infant had a false positive test feed following a positive ultrasound diagnosis. Two infants had negative test feeds. Conclusion A 1% rate of negative exploration in IHPS compares favourably with other studies. However potential causes of error were identified in all 4 cases. Confident diagnosis comprises a combination of positive test feed and an 'in house US' in an alkalotic infant. UGI contrast study should not be used in isolation to diagnose IHPS. If the test feed is negative, strict diagnostic measurements should be observed on US and the pyloric 'tumour' palpated on table under anaesthetic before exploration.

Mullassery, Dhanya; Mallappa, Sreelakshmi; Shariff, Raheel; Craigie, Ross J; Losty, Paul D; Kenny, Simon E; Pilling, David; Baillie, Colin T

2008-01-01

94

A review on functional results of sphincter-saving surgery for rectal cancer: the anterior resection syndrome.  

PubMed

The aim of this review is to characterize the functional results and "anterior resection syndrome" (ARS) after sphincter-saving surgery for rectal cancer. The purpose of sphincter-saving operations is to save the anal sphincters by avoiding the need for rectal abdomino-perineal resection with a permanent stoma. A variety of alternative techniques have been proposed and, today, ultra-low anterior resections of the rectum are commonplace. Inevitably rectal resections modify anorectal physiology. The backdrop of the functional asset for ultralow anterior resections is related to a small neorectal capacity with high endo-neorectal pressures that act together on a weakened sphincteric mechanism. Sometimes a defecation disorder called ARS may be induced and the patient experiences an extremely low quality of life. Impaired bowel function is usually provoked either by colonic dysmotility, neorectal reservoir dysfunction, anal sphincter damage or by a combination of these factors. Surgical technique defects can contribute to these possible causes: anastomotic ischemia, short length of the descending colon and stretching of neorectal mesentery may play a role. Unfortunately, there is no therapeutic algorithm or gold standard treatment that may be used for ARS. Nevertheless, it is rational to use conservative therapy first and then resort to surgery. Drugs, rehabilitative treatment and sacral neuromodulation may be used; after failure of conservative methods, surgical treatment can be considered. PMID:23754496

Pucciani, Filippo

2013-12-01

95

Pyloric motor function during emptying of a liquid meal from the stomach in the conscious pig.  

PubMed Central

1. In six conscious pigs antral, pyloric and duodenal pressures were recorded with a 5.5 cm sleeve sensor and multiple perfused side holes. The manometric assembly was positioned by dual point transmucosal potential difference measurement. Gastric emptying was measured by drainage of the proximal duodenum through a Thomas cannula. Pressures were correlated with emptying of ingested radiolabelled 5% dextrose. Alteration of emptying was produced by infusion into the more distal duodenum of nutrient and non-nutrient solutions of differing osmolalities. 2. Motor activity of the pylorus and antrum was stimulated by ingestion and modulated by intraduodenal infusion. Duodenal infusion of normal saline was associated with antro-pyloric pressure waves and rapid emptying of the ingested liquid. Duodenal infusion of dextrose, fatty acid, amino acids and hyperosmolar saline was associated with stimulation of isolated pyloric pressure waves, suppression of antral pressure waves and slowing of gastric emptying. 3. The dose-response relationship of these effects was investigated using varying rates of intraduodenal dextrose infusions. The emptying rate of the ingested liquid was inversely related to the rates of delivery of dextrose to the duodenum, directly related to the rate of antro-pyloric pressure waves and inversely related to the rate of isolated pyloric pressure waves. 4. Clearly defined episodes of pulsatile flow produced slightly more than half of the total emptying that occurred. This pulsatile flow was intimately associated in time with antro-pyloric pressure waves. Sequences of isolated pyloric pressure waves were associated with near cessation of emptying. When there were periods of absent pyloric antral pressure waves, flow rates intermediate between the rapid emptying of pulsatile flow during antro-pyloric pressure waves and the near cessation of flow during isolated pyloric pressure waves occurred. 5. The findings suggest a major role for the pylorus in the control of emptying of liquids from the stomach, both as a component of an antro-pyloric peristaltic pump and as a resistor to transpyloric flow during nutrient and hyperosmolar stimulation of duodenal receptors.

Treacy, P J; Jamieson, G G; Dent, J

1990-01-01

96

[Primary muscular antro-pyloric hypertrophy in the adult: case report].  

PubMed

Primary hypertrophic antro-pyloric stenosis in adults is a misleading anatomic and radioclinical entity. It consists of hypertrophy of the internal muscular layer. Distal gastrectomy is the only effective treatment of the symptomatic form and allows a pathologic study of the gastrectomy, thus ruling out most causes of obstruction, including neoplastic ones. Its congenital origin has not been established. We report the case of a 59 year-old man who had primary hypertrophic pyloric stenosis. PMID:10648988

Adem, C; Chetritt, J; Fabre, M; Guymar, S; Bellil, K; Bédossa, P

2000-01-01

97

Clinical and Functional Anatomy of the Urethral Sphincter  

PubMed Central

Continence and micturition involve urethral closure. Especially, insufficient strength of the pelvic floor muscles including the urethral sphincter muscles causes urinary incontinence (UI). Thus, it is most important to understand the main mechanism causing UI and the relationship of UI with the urethral sphincter. Functionally and anatomically, the urethral sphincter is made up of the internal and the external sphincter. We highlight the basic and clinical anatomy of the internal and the external sphincter and their clinical meaning. Understanding these relationships may provide a novel view in identifying the main mechanism causing UI and surgical techniques for UI.

Ahn, Hyo Kwang; Huh, Youngbuhm

2012-01-01

98

Obstetric events leading to anal sphincter damage  

Microsoft Academic Search

Objective: To identify the obstetric factors relating to anal sphincter injury at first vaginal delivery by prospective cohort study of primiparous women.Methods: We compared the results of a bowel function questionnaire and anal vector manometry before and 6 weeks after delivery in 184 primiparous women. Postpartum, pudendal nerve conduction latency was measured in all women, and anal endosonography was performed

Valerie Donnelly; Michelle Fynes; Deirdre Campbell; Howard Johnson; P. Ronan O’Connell; Colm O’Herlihy

1998-01-01

99

Peptidergic innervation of human sphincter of Oddi  

Microsoft Academic Search

The innervation of the sphincter of Oddi (SO) has been extensively studied experimentally, but human studies have not been published, which is why this study was undertaken. Biopsies, taken by gastroscopy-biopsy forceps from duodenal epithelium of the papilla of Vater and from ampullary epithelium after sphincterotomy, did not demonstrate nerves and could not be used for studying SO innervation. Therefore

Juhani Sand; Hanna Tainio; Isto Nordback

1994-01-01

100

Pancreatitis after sphincter of Oddi manometry  

Microsoft Academic Search

The nature, frequency, severity, and possible causes of complications after 207 sphincter of Oddi manometry measurements were studied in 146 patients. Acute pancreatitis was diagnosed in 6% (12 of 207) of the investigations and in 8% (12 of 146) of the patients examined. The pancreatitis was mild in all patients. After cannulation of the pancreatic duct, acute pancreatitis occurred in

P Rolny; B Anderberg; I Ihse; E Lindström; G Olaison; A Arvill

1990-01-01

101

Should we care about the internal anal sphincter?  

PubMed

The internal anal sphincter is currently regarded as a significant contributor to continence function. Four physiological and morphological aspects of the internal anal sphincter are presented as part of the current evidence base for its preservation in anal surgery. 1) The incidence of continence disturbance following deliberate internal anal sphincterotomy is underestimated, although there is presently no prospective imaging or physiologic data supporting the selective use of sphincter-sparing surgical alternatives. 2) Given that the resting pressure is a measure of internal anal sphincter function, its physiologic representation (the rectoanal inhibitory reflex) shows inherent differences between incontinent and normal cohorts which suggest that internal anal sphincter properties act as a continence defense mechanism. 3) Anatomical differences in distal external anal sphincter overlap at the point of internal anal sphincter termination may preclude internal anal sphincter division in some patients where the distal anal canal will be unsupported following deliberate internal anal sphincterotomy. 4) internal anal sphincter-preservation techniques in fistula surgery may potentially safeguard postoperative function. Prospective, randomized trials using preoperative sphincter imaging and physiologic parameters of the rectoanal inhibitory reflex are required to shape surgical decision making in minor anorectal surgery in an effort to define whether alternatives to internal anal sphincter division lead to better functional outcomes. PMID:22156875

Zbar, Andrew P; Khaikin, Marat

2012-01-01

102

Pseudodyssynergia (Contraction of the External Sphincter During Voiding) Misdiagnosed as Chronic Nonbacterial Prostatitis and the Role of Biofeedback as a Therapeutic Option  

Microsoft Academic Search

PurposeChronic lower urinary tract symptoms in young men are often attributed to misdiagnosed chronic nonbacterial prostatitis. We analyzed contraction of the external urinary sphincter during voiding (pseudodyssynergia) as an etiology of voiding dysfunction in men with misdiagnosed chronic prostatitis.

Steven A. Kaplan; Richard P. Santarosa; Patricia Meade D'Alisera; Brenda J. Fay; Edward F. Ikeguchi; James Hendricks; Lonnie Klein; Alexis E. Te

1997-01-01

103

Sphincter of Oddi-preserving and T-Tube-free Laparoscopic Management of Extrahepatic Bile Duct Calculi  

Microsoft Academic Search

Background  The current management of choledocholithiasis remains a controversial topic. Popular options for treatment include preoperative\\u000a endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) followed by laparoscopic cholecystectomy\\u000a (LC), or LC and laparoscopic common bile duct exploration (LCBDE) with T-tube decompression. Some concerns suggest that sphincterotomy\\u000a has significant long-term complications as a result of sphincter of Oddi (SO) dysfunction, and T-tube

Chun-Chih Chen; Shuo-Dong Wu; Yu Tian; Ernest Amos Siwo; Xin-Tao Zeng; Guang-Hui Zhang

104

Lower Esophageal Sphincter Is Achalasic in nNOS ?\\/? and Hypotensive in W\\/W v Mutant Mice  

Microsoft Academic Search

Background & Aims: It has been proposed that nitrergic nerves mediate lower esophageal sphincter (LES) relaxation with intramuscular interstitial cells of Cajal (ICC-IM) as an intermediary. Dysfunction of the nitrergic pathway has been shown to cause LES hypertension and impaired relaxation in achalasia. We determined whether mice with neuronal nitric oxide synthase gene disruption (nNOS?\\/?) and W\\/Wv mice lacking ICC-IM

Digavalli V. Sivarao; Hiroshi L. Mashimo; Hemant S. Thatte; Raj K. Goyal

2001-01-01

105

Pyloric stenosis in the Oxford Record Linkage Study area.  

PubMed Central

The files of the Oxford Record Linkage Study were employed to identify 220 infants presenting with infantile hypertrophic pyloric stenosis (IHPS) in the 6-year period 1966 to 1971. Information on these infants was obtained from birth certificates and maternity notes. The overall incidence was 2.5 per 1000 livebirths. There was a distinct seasonal variation, with highest incidence to infants born in the third quarter of the year as well as variation in incidence with area: the cities had much lower rates of IHPS than the adjacent rural or small urban areas. It was shown that the rates in the south and east of the area studied were far greater than in the north and west. In the present study there was no excess of primiparae, the peak maternal age group was 20 to 24; there was a slight excess of parents of social classes I and II; and a significant association with mothers who were Rhesus negative. The rate of IHPS among sibs was 85 per 1000. Though there was the usual correlation with the male sex (M:F ratio = 5.5:1), there was no variation with birthweight and only among the females was an association found with prolonged gestation. There appeared to be an inverse relation between gestation and age on admission to hospital. Images

Adelstein, P; Fedrick, J

1976-01-01

106

Through-the-scope balloon dilatation of benign pyloric stenoses.  

PubMed

In 9 patients with benign pyloric stenosis, the stenosis was dilated using through-the-scope (TTS) balloon catheters (diameter 1.5 to 1.8 cm), which can be passed through the biopsy channel of a standard fiberscope under direct vision. In all cases, the stenosis was secondary to fibrous changes in peptic ulcer disease. In addition, all patients had active ulcers. All dilatation treatments were primarily successful: the stenoses were opened for the passage of the fiberscope. There were no complications; even with active ulcers there were no side effects. The treatment was followed by immediate symptomatic relief. On prospective evaluation over a period of 7 months (mean), 6 patients remained asymptomatic, 2 patients had to be dilated again for restenosis and have since been asymptomatic for 1 and 12 months, respectively. One patient had to undergo surgery after 7 months for ulcer perforation into the common bile duct. The TTS technique has considerable advantages over the methods requiring a guide wire. This technique with its easy practicability and low incidence of complications may become a valid alternative to surgical procedures if the good initial results can be confirmed in further studies. PMID:2917542

Schmüdderich, W; Harloff, M; Riemann, J F

1989-01-01

107

Sphincter repair for fecal incontinence after obstetrical or iatrogenic injury  

Microsoft Academic Search

Forty patients with fecal incontinence underwent sphincter repair between 1975 and 1984. Divided sphincter musculature resulted\\u000a from obstetrical injury in 23 and previous anorectal surgery in 17. Eighteen had undergone a previous attempt at repair. Fifteen\\u000a patients experienced seepage of stool and 25 had gross incontinence. In nine patients, reconstruction of the external sphincter\\u000a was by overlap of the muscle

Michael E. Pezim; Robert J. Spencer; C. Robert Stanhope; Robert W. Beart; Roger L. Ready; Duane M. Ilstrup

1987-01-01

108

Effect of somatostatin analog octreotide on human sphincter of Oddi  

Microsoft Academic Search

The effect of the long-acting somatostatin analog octreotide on the sphincter of Oddi was investigated in seven subjects referred for endoscopic sphincter of Oddi manometry. Six patients had unexplained right upper quadrant pain and one had bile duct dilatation without evidence of fixed obstruction on endoscopic retrograde cholangiopancreatography. A triple-lumen low-compliance system was used to record the sphincter of Oddi

Kenneth F. Binmoeller; Remy Dumas; Alan G. Harris; J. P. Delmont

1992-01-01

109

Effect of cimetidine on the human lower oesophageal sphincter.  

PubMed Central

Lower oesophageal sphincter pressures in healthy volunteers were measured by a rapid pull-through technique during intravenous infusion of the histamine H2-receptor antagonist, cimetidine. No consistent effects on sphincter pressure were observed which are liable to be of clinical importance. Serum gastrin concentrations during cimetidine infusion were measured by radioimmunoassay and showed no significant variation. In a further series of experiments, the response of the lower oesophageal sphincter to intravenous bolus injection of pentagastrin was measured before and during cimetidine infusion. Cimetidine infusion had no significant effect on the sphincter response to pentagastrin.

Osborne, D H; Lennon, J; Henderson, M; Lidgard, G; Creel, R; Carter, D C

1977-01-01

110

Confirmation of two novel loci for infantile hypertrophic pyloric stenosis on chromosomes 3 and 5.  

PubMed

Infantile hypertrophic pyloric stenosis (IHPS) is a multifactorial heritable condition affecting infants in the first 3 months of life. It is characterized by hypertrophy of the pylorus resulting in blockage of the pyloric canal. Patients present with projectile vomiting, weight loss and dehydration. Five susceptibility loci have been identified through genome-wide linkage analysis and candidate gene approaches. The first genome-wide association study was recently performed and three statistically significant associations identified. Here, we report our confirmation of two of these significant results thus providing further support for new loci for IHPS on chromosome 3p25.1 and chromosome 5q35.2. PMID:23426030

Everett, Kate V; Chung, Eddie M K

2013-04-01

111

Laparoscopic management of pyloric atresia in a neonate with epidermolysis bullosa.  

PubMed

Pyloric atresia (PA) is rare and may be associated with epidermolysis bullosa (EB). This is the first case report of a successful laparoscopic treatment of PA in a full-term 7-day-old neonate with EB. The laparoscopic approach consists of a longitudinal pyloromyotomy and excision of the thick obstructing pyloric membrane with a Heineke-Mickulicz pyloroplasty closure. Oral feeding was resumed at postoperative Day 7, and the child was discharged 5 days later with satisfactory follow-up at 8 months. Recommendations are provided for the management of the neonate with PA/EB. PMID:23755856

Son, Tran Ngoc; Hoan, Vu Xuan

2013-07-01

112

[Recurrent pyloric stenosis in a 7-year-old child with chronic granulomatous disease].  

PubMed

Hypertrophic pyloric stenosis is a common affection in infants aged 3-8 weeks and typically does not affect older children. We report a case of pyloric stenosis that occurred recurrently at the ages of 3 and 7 years in a boy with X-linked chronic granulomatous disease. We emphasize the inflammatory origin of such stenosis, whose progression was favorable thanks exclusively to drug treatment with corticosteroids. We note that chronic granulomatous disease can affect the entire digestive tract, similar to inflammatory bowel disease in children. PMID:24182666

Perdereau, S; Touzot, F; Robin, L; Hébert, C; Monceaux, F; Dimitrov, G

2013-12-01

113

Control of a central pattern generator by an identified modulatory interneurone in crustacea. II. Induction and modification of plateau properties in pyloric neurones.  

PubMed

In the isolated stomatogastric nervous system of the lobster Fasus lalandii, the strong modifications of the pyloric motor pattern induced by firing of the single anterior pyloric modulator neurone (APM) are due primarily to modulation by APM activity of the regenerative membrane properties which are responsible for the 'burstiness' of all the pyloric neurones and particularly of the non-pacemaker neurones (constrictor motoneurones). This modulation has been studied under experimental conditions where the main extrinsic influences usually received by the pyloric constrictor neurones (intra-network synaptic interactions, activity of pacemaker neurones, and phasic central inputs from two premotor centres) are minimal. Under these conditions a brief discharge of neurone APM induces long plateaus of firing in all of the pyloric neurones. The non-pacemaker neurones of the pyloric network are not simply passive follower neurones, but can produce regenerative depolarizations (plateau potentials) during which the neurones fire spikes. The ability of the pyloric constrictor neurones to produce plateau potentials (plateau properties) contributes greatly to the generation of the rhythmical pyloric motor pattern. When these neurones spontaneously express their plateau properties, firing of neurone APM amplifies these properties. When most of the central inputs usually received by the pyloric constrictor neurones are experimentally suppressed, these neurones can no longer produce plateau potentials. In such conditions, firing of the single modulatory neurone APM can reinduce plateau properties of the pyloric constrictor neurones. In addition, firing in APM neurone slows down the active repolarization phase which terminates the plateau potentials of pyloric constrictor neurones. This effect is long-lasting and voltage-dependent. Modulation by APM of the plateau properties of the pyloric neurones also changes the sensitivity of these neurones to synaptic inputs. This effect can explain the strong modifications that an APM discharge exerts on a current pyloric motor pattern. Moreover, it might render the motoneurones of the pyloric pattern generator more sensitive to inputs from a command oscillator, and contribute to switching on the pyloric motor pattern. PMID:6619733

Dickinson, P S; Nagy, F

1983-07-01

114

Urethral Sphincter EMG as Event Detector for Neurogenic Detrusor Overactivity  

Microsoft Academic Search

The aim of this study was to investigate the feasibility of using external urethral sphincter electromyogram (EMG) (EUSEMG) to detect the onset of detrusor contractions in patients with both neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD). Detrusor pressure (Pdet) and EUSEMG was recorded in 23 neurogenic patients during slow artificial bladder filling. The time delay between the onset

John Hansen; Albert Borau; Alfred Rodríguez; Joan Vidal; T. Sinkjaer; N. J. M. Rijkhoff

2007-01-01

115

Abnormalities of innervation of internal anal sphincter in fecal incontinence  

Microsoft Academic Search

Physiological and histological studies have shown that the internal anal sphincter is abnormal in idiopathic fecal incontinence. We have recently demonstrated that the invitro contractile response of the internal anal sphincter to the sympathetic neurotransmitter noradrenaline is decreased in incontinence. In this study we have further defined this reduced sensitivity and provided more information about the intrinsic innervation in both

Christopher T. M. Speakman; Charles H. V. Hoyle; Michael M. Kamm; Michael M. Henry; R. John Nicholls; Geoffrey Burnstock

1993-01-01

116

A rare occurrence of pyloric stenosis in an infant with osteogenesis imperfecta: Anesthetic implications  

PubMed Central

Congenital anomalies pose many challenges during anesthesia due to anatomic and physiological alterations. The inherent complications associated with the disorders necessitate vigilance for providing anesthesia to even seemingly simple surgical intervention. Here, we share our experience of anesthesia management of an infant of congenital osteogenesis imperfecta with pyloric stenosis for pyloromyotomy.

Jagtap, Sheetal R; Bakhshi, Rochana G; Jain, Ankit

2014-01-01

117

A rare occurrence of pyloric stenosis in an infant with osteogenesis imperfecta: Anesthetic implications.  

PubMed

Congenital anomalies pose many challenges during anesthesia due to anatomic and physiological alterations. The inherent complications associated with the disorders necessitate vigilance for providing anesthesia to even seemingly simple surgical intervention. Here, we share our experience of anesthesia management of an infant of congenital osteogenesis imperfecta with pyloric stenosis for pyloromyotomy. PMID:24803772

Jagtap, Sheetal R; Bakhshi, Rochana G; Jain, Ankit

2014-04-01

118

Hypertrophic Pyloric Stenosis developing In a Patient Operated for Patent Urachus - A Case Report  

PubMed Central

A neonate with patent urachus (PU) who later developed hypertrophic pyloric stenosis (HPS) is being reported. The newborn was first operated for PU; post-operatively he developed persistent vomiting and radiological workup confirmed HPS. Pyloromyotomy was performed with an uneventful recovery.

Jangid, Manoj Kumar; Yadav, Sunil Kumar; Taqi, Esmaeel

2014-01-01

119

Uncommon congenital antral web misdiagnosed twice as a pyloric ulcer: successful treatment with endoscopic balloon dilatation.  

PubMed

Congenital antral webs are quite rare and easily overlooked or misdiagnosed. We report the case of a five-year-old boy who presented with symptoms of gastric outlet obstruction for four years; his condition was misdiagnosed twice as pyloric ulcer. Detailed gastroscopy revealed a congenital antral web. The stricture was successfully treated with endoscopic balloon dilatation without surgery. PMID:24827957

Lu, Jung Ping; Huang, Ying; Wu, Jie; Chen, Shi Yao

2014-01-01

120

Endocrine cells in the antro-pyloric mucosa of the stomach  

Microsoft Academic Search

A type of endocrine-like cell displaying all morphological features of protein secreting cells, has been found in the antro-pyloric mucosa of the stomach of mammals. Light and electron microscopy observations provide a sharp distinction of this cell from the 5-hydroxytryptamine-storing enterochromaffin cell. Its possible involvement in the secretion of a protein or peptide hormone is discussed.

E. Solcia; G. Vassallo; R. Sampietro

1967-01-01

121

Florid Endocervical Glandular Hyperplasia with Intestinal and Pyloric Gland Metaplasia: Worrisome Benign Mimic of “Adenoma Malignum”  

Microsoft Academic Search

We describe three cases of florid endocervical glandular hyperplasia with intestinal and pyloric gland metaplasia, which can be a benign mimic of adenoma malignum. In two cases, adenoma malignum was seriously considered preoperatively because of watery vaginal discharge and the results of imaging studies. The three cases shared common histopathological features, i.e., (i) proliferating endocervical glands surrounded by clusters of

Yoshiki Mikami; Sakae Hata; Keiichi Fujiwara; Yoshinari Imajo; Ichiro Kohno; Toshiaki Manabe

1999-01-01

122

Optimization of the artificial urinary sphincter: modelling and experimental validation  

NASA Astrophysics Data System (ADS)

The artificial urinary sphincter should be long enough to prevent strangulation effects of the urethral tissue and short enough to avoid the improper dissection of the surrounding tissue. To optimize the sphincter length, the empirical three-parameter urethra compression model is proposed based on the mechanical properties of the urethra: wall pressure, tissue response rim force and sphincter periphery length. In vitro studies using explanted animal or human urethras and different artificial sphincters demonstrate its applicability. The pressure of the sphincter to close the urethra is shown to be a linear function of the bladder pressure. The force to close the urethra depends on the sphincter length linearly. Human urethras display the same dependences as the urethras of pig, dog, sheep and calf. Quantitatively, however, sow urethras resemble best the human ones. For the human urethras, the mean wall pressure corresponds to (-12.6 ± 0.9) cmH2O and (-8.7 ± 1.1) cmH2O, the rim length to (3.0 ± 0.3) mm and (5.1 ± 0.3) mm and the rim force to (60 ± 20) mN and (100 ± 20) mN for urethra opening and closing, respectively. Assuming an intravesical pressure of 40 cmH2O, and an external pressure on the urethra of 60 cmH2O, the model leads to the optimized sphincter length of (17.3 ± 3.8) mm.

Marti, Florian; Leippold, Thomas; John, Hubert; Blunschi, Nadine; Müller, Bert

2006-03-01

123

Effect of cholecystokinin on lower oesophageal sphincter pressure and transient lower oesophageal sphincter relaxations in humans  

Microsoft Academic Search

The effect of cholecystokinin (CCK) on the lower oesophageal sphincter (LOS) pressure, frequency of transient LOS relaxations, and the number of reflux episodes was investigated in six healthy subjects. LOS pressure was recorded on four separate occasions during continuous intravenous infusion of either saline or CCK-33 in doses of 0.25, 0.5, or 1.0 Ivy Dog units per kg body weight

M. Ledeboer; A. A. M. Masclee; M. R. Batstra; J. B. M. J. Jansen; C B Lamers

1995-01-01

124

Sphincter anal artificiel dans l’incontinence anale sévère  

Microsoft Academic Search

\\u000a Résumé  \\u000a Objectif: Evaluer le résultat de l’implantation d’un sphincter anal artificiel pour incontinence fécale sévère chez 56 patients opérés\\u000a dans le même hôpital. L’implantation d’un sphincter anal artificiel est proposé dans le cadre de l’incontinence anale sévère\\u000a lorsque le traitement local n’est pas adapté ou a échoué.\\u000a \\u000a \\u000a Méthodes: Un sphincter anal artificiel a été implanté chez 56 patients de 1993

F. Michot; Anne-Marie Leroi; Ph. Denis

2004-01-01

125

[Anal sphincter injury caused by falling off a trampoline].  

PubMed

A girl of preschool age fell off a trampoline in a sitting position onto an iron bar sticking up from the ground. In addition to a laceration of the terminal portion of the rectum, she was found to have a severe sphincter injury. The sphincters were repaired by a surgeon the next morning. After one month from the surgery the anal canal pressure was found to be symmetrical with good contractile force of the sphincters. No abnormalities were found in a contrast study or in rectoscopy. The protective stoma was closed after three months from the injury and fecal continence was normal after one and a half years. PMID:23901741

Pakarinen, Mikko

2013-01-01

126

Bladder, Bowel, and Sexual Dysfunction in Parkinson's Disease  

PubMed Central

Bladder dysfunction (urinary urgency/frequency), bowel dysfunction (constipation), and sexual dysfunction (erectile dysfunction) (also called “pelvic organ” dysfunctions) are common nonmotor disorders in Parkinson's disease (PD). In contrast to motor disorders, pelvic organ autonomic dysfunctions are often nonresponsive to levodopa treatment. The brain pathology causing the bladder dysfunction (appearance of overactivity) involves an altered dopamine-basal ganglia circuit, which normally suppresses the micturition reflex. By contrast, peripheral myenteric pathology causing slowed colonic transit (loss of rectal contractions) and central pathology causing weak strain and paradoxical anal sphincter contraction on defecation (PSD, also called as anismus) are responsible for the bowel dysfunction. In addition, hypothalamic dysfunction is mostly responsible for the sexual dysfunction (decrease in libido and erection) in PD, via altered dopamine-oxytocin pathways, which normally promote libido and erection. The pathophysiology of the pelvic organ dysfunction in PD differs from that in multiple system atrophy; therefore, it might aid in differential diagnosis. Anticholinergic agents are used to treat bladder dysfunction in PD, although these drugs should be used with caution particularly in elderly patients who have cognitive decline. Dietary fibers, laxatives, and “prokinetic” drugs such as serotonergic agonists are used to treat bowel dysfunction in PD. Phosphodiesterase inhibitors are used to treat sexual dysfunction in PD. These treatments might be beneficial in maximizing the patients' quality of life.

Sakakibara, Ryuji; Kishi, Masahiko; Ogawa, Emina; Tateno, Fuyuki; Uchiyama, Tomoyuki; Yamamoto, Tatsuya; Yamanishi, Tomonori

2011-01-01

127

Manometric measurement of human sphincter of Oddi length.  

PubMed Central

Length of biliary (CBD) and/or pancreatic (PD) sphincter of Oddi (SO) was measured during perendoscopic or intraoperative manometry in 21 control subjects and in 46 patients with biliary disease. When the high resting pressure (HPZ) and the phasic wave zone (PAZ) were considered, SO length was, in the control group, 9.5 +/- 0.5 mm (M +/- SE) and 9.4 +/- 0.6 mm at the level of the CBD-SO, and 7.7 +/- 0.6 mm and 6.9 +/- 0.5 mm at the level of the PD-SO. The physiological sphincter length appeared substantially shorter than the anatomical one, as reported in the literature. No significant differences were found between controls and patients with CBD stones. Endoscopic sphincterotomy without manometry reduced mean sphincter length length of the sphincterotomy was tailored to the manometric findings. Surgical partial sphincterotomy reduced sphincter length by only 46.7 +/- 10.3%.

Habib, F I; Corazziari, E; Biliotti, D; Primerano, L; Viscardi, A; Speranza, V; De Masi, E; Fegiz, G; Torsoli, A

1988-01-01

128

[Hypertrophic pyloric stenosis in infants. A retrospective study of cases observed in the years 1970-1990].  

PubMed

Although the definitive cause of infantile hypertrophic pyloric stenosis is unknown, it's probable that several predisposing risk factors would be associated with the condition. We analysed some perinatal factors in relation to the incidence of infantile hypertrophic pyloric stenosis among children observed during the period 1970-90. We examined 61 infants with surgically confirmed hypertrophic pyloric stenosis and, as controls, 61 healty children comparable for age. In every child we studied: sex, birth rank, pregnancy and delivery, birthweight, parental age, type of feeding, familial history of hypertrophic pyloric stenosis and of atopy, seasonal variation in incidence, AB0 and Rh blood phenotypes. In the 61 infants with hypertrophic pyloric stenosis, the incidence of three factors (male sex, primogeniture and feeding with artificial milk) was significantly higher than that in the controls. We conclude that infantile hypertrophic pyloric stenosis probably has a particular genetic basis, but perinatal factors are responsible for the rising of the condition. However the true aetiology remains to be elucidated. PMID:1461785

Ceccarelli, M; Villirillo, A; Assanta, N; Balsano, L; Chiaravalloti, G

1992-01-01

129

Memokath® stents for the treatment of detrusor sphincter dyssynergia (DSD) in men with spinal cord injury: The Princess Royal Spinal Injuries Unit 10-year experience  

Microsoft Academic Search

Study design:Medical records review.Objective:To assess the effectiveness of the Memokath (Engineers & Doctors A\\/S, Denmark) thermosensitive stent as a ‘nondestructive’ means of reducing bladder outlet resistance by treating detrusor sphincter dyssynergia (DSD) of neurogenic bladder dysfunction associated with spinal cord injury.Setting:Spinal Injuries Unit, Sheffield, England.Methods:A medical records review was performed to examine our experience of Memokaths over the last 10

S S Mehta; P R Tophill

2006-01-01

130

Use of 99mTc-DISIDA biliary scanning with morphine provocation for the detection of elevated sphincter of Oddi basal pressure  

Microsoft Academic Search

BACKGROUNDEndoscopic biliary manometry is useful in the assessment of patients with types II and III sphincter of Oddi dysfunction, but it is time consuming and invasive.AIMTo investigate the role of 99mTc-DISIDA scanning, with and without morphine provocation, as a non-invasive investigation in these patients compared with endoscopic biliary manometry.SUBJECTS AND METHODSA total of 34 patients with a clinical diagnosis of

P D Thomas; J G Turner; B R Dobbs; M J Burt; B A Chapman

2000-01-01

131

Bethanechol chloride in neurogenic bladder dysfunction.  

PubMed

Representative case summaries of patients with different types of neurogenic bladder diagnosed by combined cystometric-perineal electromyography and treated with bethanechol (Urecholine) are presented. Determination of the activity of the periurethral striated muscle in relation to bladder dysfunction is extremely important in the selection of patients for bethanechol therapy. In the absence of structural obstruction, bethanechol can be used in patients with (1) the early phase of coordinated reflex neurogenic bladder and sphincter when there is incomplete bladder emptying due to feeble or unsustained detrusor contractions, (2) recovery phase of spinal shock when the periurethral striated muscle has recovered and is under voluntary control, (3) incomplete motor paralytic bladder with coordinated sphincter, and (4) sensory paralytic bladder with decompensation. The bethanechol regimen will vary in accordance with the type of bladder being treated. PMID:982732

Diokno, A C; Koppenhoefer, R

1976-11-01

132

D2 plus radical resection combined with perioperative chemotherapy for advanced gastric cancer with pyloric obstruction  

PubMed Central

A patient with advanced gastric cancer complicated with pyloric obstruction was treated using D2 + radical resection combined with perioperative chemotherapy, and had satisfying outcomes. The perioperative chemotherapy regimen was Taxol and S1 (tegafur, gimeracil, and oteracil). Three cycles of neoadjuvant chemotherapy were delivered before surgery, and three cycles of adjuvant therapy after surgery. PR was achieved after chemotherapy. D2 + dissection of stations 8p, 12b, 12p, 13 and 14v lymph nodes was performed on September 10, 2012.

Du, Yian; Xu, Zhiyuan; Yang, Litao; Huang, Ling; Wang, Bing; Yu, Pengfei; Dong, Ruizeng

2013-01-01

133

Isolation and characterization of trypsin from pyloric caeca of Monterey sardine Sardinops sagax caerulea  

Microsoft Academic Search

Trypsin from pyloric caeca of Monterey sardine was purified by fractionation with ammonium sulfate, gel filtration, affinity and ionic exchange chromatography. Fraction 102, obtained from ionic exchange chromatography, generated one band in sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and isoelectric focusing. The molecular mass of the isolated trypsin was 25 kDa and showed esterase-specific activity on N?-p-tosyl-l-arginine methyl ester (TAME)

Francisco Javier Castillo-Yáñez; Ramón Pacheco-Aguilar; Fernando Luis García-Carreño

2005-01-01

134

Structural immaturity of the pylorus muscle in infantile hypertrophic pyloric stenosis  

Microsoft Academic Search

Recent reports indicate that extracellular matrix and cytoskeleton plasmalemmal elements are altered in infantile hypertrophic\\u000a pyloric stenosis (IHPS). Desmin is a cytoskeletal protein that is important for the organization and function of muscular\\u000a fibers. It has been found to be increased in the smooth muscle in chronic intestinal pseudo-obstruction and in skeletal muscle\\u000a in some forms of myopathies as well

N. Guarino; H. Shima; P. Puri

2000-01-01

135

Pyloric neuron morphology in the stomatogastric ganglion of the lobster, Panulirus interruptus.  

PubMed

The pyloric network of decapod crustaceans has been intensively studied electrophysiologically in the infraorders Astacidea, Brachyura, and Palinura. The morphology of some or all pyloric neurons has been well described in Astacidea and Brachyura, but less so in Palinura. Given the large evolutionary distance between these three groups, and the large amount of electrophysiology that has been performed in palinuroid species, it is important to fill this gap. We describe here the gross morphology of all six pyloric neuron types in a palinuroid, P. interruptus. All pyloric neurons had complicated, extended dendritic trees that filled the majority of the neuropil, with most small diameter processes present in a shell near the surface of the ganglion. Certain neuron types showed modest preferences for somata location in the ganglion, but these differences were too weak to use as identifying characteristics. Quantitative measurements of secondary branch number, maximum branch order, total process length, and neuron somata diameter were also, in general, insufficient to distinguish among the neurons, although AB and LP neuron somata diameters differed from those of the other types. One neuron type (VD) had a distinctive neurite branching pattern consisting of a small initial branch followed shortly by a bifurcation of the main neurite. The processes arising from these two branches occupied largely non-overlapping neuropil. Electrophysiological recordings showed that each major branch had its own spike initiation zone and that, although the zones fired correlated spikes, they generated spikes independently. VD neurons in the other infraorders have similar morphologies, suggesting that having two arbors is important for the function of this neuron. These data are similar to those previously obtained in Brachyura and Astacidea. It thus appears that, despite their long evolutionary separation, neuron morphology in these three infraorders has not greatly diverged. PMID:19223685

Thuma, Jeffrey B; White, William E; Hobbs, Kevin H; Hooper, Scott L

2009-01-01

136

Plectin deficiency leads to both muscular dystrophy and pyloric atresia in epidermolysis bullosa simplex.  

PubMed

Plectin is a cytoskeletal linker protein which has a long central rod and N- and C-terminal globular domains. Mutations in the gene encoding plectin (PLEC) cause two distinct autosomal recessive subtypes of epidermolysis bullosa: EB simplex (EBS) with muscular dystrophy (EBS-MD), and EBS with pyloric atresia (EBS-PA). Previous studies have demonstrated that loss of full-length plectin with residual expression of the rodless isoform leads to EBS-MD, whereas complete loss or marked attenuation of expression of full-length and rodless plectin underlies the more severe EBS-PA phenotype. However, muscular dystrophy has never been identified in EBS-PA, not even in the severe form of the disease. Here, we report the first case of EBS associated with both pyloric atresia and muscular dystrophy. Both of the premature termination codon-causing mutations of the proband are located within exon 32, the last exon of PLEC. Immunofluorescence and immunoblot analysis of skin samples and cultured fibroblasts from the proband revealed truncated plectin protein expression in low amounts. This study demonstrates that plectin deficiency can indeed lead to both muscular dystrophy and pyloric atresia in an individual EBS patient. PMID:20665883

Natsuga, Ken; Nishie, Wataru; Shinkuma, Satoru; Arita, Ken; Nakamura, Hideki; Ohyama, Makiko; Osaka, Hitoshi; Kambara, Takeshi; Hirako, Yoshiaki; Shimizu, Hiroshi

2010-10-01

137

Sphincter of Oddi stenosis: diagnosis using hepatobiliary scintigraphy and endoscopic manometry  

SciTech Connect

To determine the role of radionuclide imaging in diagnosing sphincter of Oddi stenosis, 21 patients with symptoms suggesting this disorder underwent endoscopic retrograde cholangiopancreatography, cholescintigraphy, and, when possible, endoscopic manometry. Those patients with abnormal hepatobiliary scintigraphy results had a mean basal sphincter pressure of 38.5 mm Hg. Sphincter pressures could not be measured in six patients with sphincters too tight to cannulate. Ten patients who underwent hepatobiliary scanning both before and after sphincter surgery had normal scan results of the repeat study. Hepatobiliary imaging appears useful for diagnosis of sphincter of Oddi stenosis in selected patients in whom manometry cannot be performed and for objective assessment of response to therapy.

Lee, R.G.L.; Gregg, J.A.; Koroshetz, A.M.; Hill, T.C.; Clouse, M.E.

1985-09-01

138

[Sphincter-preserving radiotherapy of anal carcinoma].  

PubMed

During the last decade radiotherapy, in combination with chemotherapy, has become the treatment of choice in cure of anal carcinoma with preservation of anal function, and has replaced abdominoperineal resection (APR). From 1979-1990 54 patients with anal carcinoma were treated by radiotherapy. 24 patients received radiotherapy after APR (12 adjuvant, 12 after recurrence). 11 received palliative radiotherapy without prior APR. 19 patients were treated curatively, 17 of whom received a combination of external irradiation followed by interstitial iridium implantation in a split course regimen. 11 of the 19 patients received short simultaneous chemotherapy (mitomycin C and 5-fluorouracil). All 19 patients had a complete remission. 18/19 patients had no local recurrence after mean 14 months' follow-up. 2 patients developed regional recurrence. 3 patients died of other causes. Colostomy was necessary in 5/19 patients with anal necrosis which was dose-related. The maximum tolerated dose was 71.4 Gy. Our results support the recommendation in the literature of primary, curative, radiotherapy and chemotherapy of anal carcinoma with preservation of the anal sphincter. PMID:1439687

Thöni, A F; Greiner, R; Peyer, T; Leicht, E; Lampret, T; Feuz, J

1992-10-31

139

Vagal control of lower oesophageal sphincter motility in the cat  

PubMed Central

1. The effects of vagal efferent fibre stimulation on the smooth muscle of the lower oesophageal sphincter have been studied on the anaesthetized animal and on the isolated and perfused organ. 2. In both muscle layers (longitudinal and circular) vagal stimulation elicits two types of electromyographic (e.m.g.) potentials: (a) excitatory junction potentials (e.j.p.s) where there is a depolarization of the smooth muscle fibres. E.j.p.s can give rise to spike potentials inducing a contraction of the sphincter; (b) inhibitory junction potentials (i.j.p.s) where there is hyperpolarization of the smooth muscle fibres, often followed by a transient depolarization which may initiate spikes (post-inhibitory rebound). 3. Pure i.j.p.s are observed after atropine treatment which suppresses e.j.p.s. Under these conditions, a long lasting vagal stimulation induces a long duration hyperpolarization concomitant with an opening of the lower oesophageal sphincter followed after the cessation of stimulation by a powerful rebound leading to a strong contraction which closes the sphincter. 4. Several arguments, pharmacological (action of acetylcholine (ACh), atropine and hexamethonium) and physiological (threshold and latency of responses) lead to the following conclusions. Preganglionic vagal fibres are cholinergic and they activate (a) intramural excitatory cholinergic neurones; (b) intramural non-adrenergic inhibitory neurones (purinergic neurones). Preganglionic fibres leading to inhibition have a higher threshold than those leading to excitation. Both excitatory and inhibitory pathways are interconnected inside the intramural network. In particular, activation of intramural inhibitory neurones, by relaxing the oesophagus orally to the lower oesophageal sphincter, inhibits intramural excitatory neurones and subsequently blocks vagal excitatory responses. 5. Two functions may be attributed to the vagal extrinsic innervation: (a) closure of the lower oesophageal sphincter by maintaining the basal tone of the sphincter; this would imply that at rest the inhibitory control is supplanted by the excitatory one; (b) sphincter opening during swallowing by suppressing the excitatory stimulus and reinforcing the inhibitory one (it may be recalled that after bilateral vagotomy, swallowing is no longer followed by a relaxation of the sphincter).

Gonella, J.; Niel, J. P.; Roman, C.

1977-01-01

140

Prostaglandin E2 and the bovine sphincter pupillae  

PubMed Central

1. The bovine isolated sphincter pupillae incubated in Krebs solution releases a biologically active substance tentatively identified as prostaglandin E2. 2. The prostaglandin did not appear to be of neural origin or to result merely from tissue degeneration. 3. The spontaneous release of prostaglandin E2-like material was related to the tone of the sphincter. Output increased as tone was acquired after setting up the tissue and fell when various procedures were used to reduce the tone. 4. Low concentrations of E and F-type prostaglandins produced slow, well-sustained contractions of the atonic sphincter, prostaglandin E2 being the most potent of those tested. The responses to prostaglandin E2 were antagonized selectively by a prostaglandin antagonist SC-19220 (a dibenzoxazepine derivative) which in higher concentrations caused dose-dependent relaxations of the preparation. 5. Prostaglandins did not appear to modulate transmission from nerve to muscle in the sphincter. 6. The hypothesis that prostaglandin E2 might be produced to act as a local hormone causing tonic contraction of the sphincter pupillae is discussed.

Posner, J.

1973-01-01

141

Adaptive transcutaneous power delivery for an artificial anal sphincter system.  

PubMed

For controlling anal incontinence, a novel artificial anal sphincter system with sensor feedback based on transcutaneous energy transmission was developed. The device mainly comprises an artificial anal sphincter, a wireless power supply subsystem, and a communication subsystem. A transcutaneous power delivery system employing a class-E power amplifier, based on the adaptive control technique, is discussed in this paper. Amplitude modulation of the class-E power amplifier is integrated in the system and applied for the adaptive transcutaneous power delivery. Optimization of the power transfer efficiency and the misalignment tolerance is obtained. Experiments show that the system is capable of delivering at least 150 mW, with a power transfer efficiency of 41% over a distance of 3 cm, which can meet the electric power requirements of the artificial anal sphincter system. The power transfer frequency is 760 kHz. PMID:19085203

Zan, P; Yan, G; Liu, H; Luo, N; Zhao, Y

2009-01-01

142

Topical diltiazem and bethanechol decrease anal sphincter pressure without side effects  

Microsoft Academic Search

BACKGROUNDTopical nitrates lower anal sphincter pressure and heal anal fissures, but a majority of patients experience headache. The internal anal sphincter has a calcium dependent mechanism to maintain tone, and also receives an inhibitory extrinsic cholinergic innervation. It may therefore be possible to lower anal sphincter pressure using calcium channel blockers and cholinergic agonists without side effects.AIMSTo investigate the effect

E A Carapeti; M A Kamm; B K Evans; R K S Phillips

1999-01-01

143

Thermal control of shape memory alloy artificial anal sphincters for complete implantation  

Microsoft Academic Search

This paper presents an approach for the thermal control of an artificial anal sphincter using shape memory alloys. An artificial anal sphincter has been proposed by the authors to resolve problems of severe fecal incontinence in patients. The basic design of the artificial sphincter consists of two all-round shape memory alloy plates as the main functional parts, and heaters that

Yun Luo; Takeshi Okuyama; Toshiyuki Takagi; Takamichi Kamiyama; Kotaro Nishi; Tomoyuki Yambe

2005-01-01

144

Neuroanatomy of the External Urethral Sphincter: Implications for Urinary Continence Preservation During Radical Prostate Surgery  

Microsoft Academic Search

Post-prostatectomy urinary incontinence probably is multifactorial and sphincteric nerve injury could be a contributing cause. Controversy still exists regarding the innervation of the external sphincter, and currently pudendal nerve injury is not believed to be an etiological factor in post-prostatectomy urinary incontinence. To understand better the sphincter and its innervation, we undertook an anatomical and histological study of 18 adult

Perinchery Narayan; Badrinath Konety; Khalid Aslam; Sherif Aboseif; Walter Blumenfeld; Emil. Tanagho

1995-01-01

145

Distension of the gall bladder inhibits sphincter of Oddi motility in humans  

Microsoft Academic Search

Studies in animals have suggested a neural reflex between the gall bladder and the sphincter of Oddi. The aim of this study was to investigate whether sphincter of Oddi motility is altered by distension of the gall bladder in humans. Sphincter of Oddi motility was recorded intraoperatively in 10 patients undergoing elective cholecystectomy for gall stones. The manometry was performed

A Thune; G T Saccone; J P Scicchitano; J Toouli

1991-01-01

146

The iris sphincter in aberrant regeneration of the third nerve.  

PubMed

Fourteen patients with aberrant regeneration of the third cranial nerve were examined using self-developing photographs, motion pictures, and pupillography. These pupillary phenomena were noted: (1) sector contractions of the iris sphincter in response to light, (2) sector contractions of the iris sphincter associated with eye movements, and (3) an abnormal pupillary unrest. The observations strongly support the concept that after injury, fibers regenerate and sprout collateral branches that finally reach muscles of the oculomotor group other than those originally innervated. PMID:687202

Czarnecki, J S; Thompson, H S

1978-09-01

147

Ultrasound imaging of the anal sphincter complex: a review  

PubMed Central

Endoanal ultrasound is now regarded as the gold standard for evaluating anal sphincter pathology in the investigation of anal incontinence. The advent of three-dimensional ultrasound has further improved our understanding of the two-dimensional technique. Endoanal ultrasound requires specialised equipment and its relative invasiveness has prompted clinicians to explore alternative imaging techniques. Transvaginal and transperineal ultrasound have been recently evaluated as alternative imaging modalities. However, the need for technique standardisation, validation and reporting is of paramount importance. We conducted a MEDLINE search (1950 to February 2010) and critically reviewed studies using the three imaging techniques in evaluating anal sphincter integrity.

Abdool, Z; Sultan, A H; Thakar, R

2012-01-01

148

Gastric distension-induced pyloric relaxation: central nervous system regulation and effects of acute hyperglycaemia in the rat.  

PubMed

1. The pylorus plays an important role in the regulation of gastric emptying. In addition to the autonomic neuropathy associated with long-standing diabetes, acute hyperglycaemia per se has effects on gastric emptying. In this study, the role of the central nervous system in modulating the effects of hyperglycaemia on gastric distension-induced pyloric relaxation was investigated. 2. Gastric distension-induced pyloric relaxation was significantly reduced by subdiaphragmatic vagotomy, hexamethonium (20 mg kg(-1)) and N (G)-nitro-L-arginine methyl ester (L-NAME; 10 mg kg(-1)), a nitric oxide synthase (NOS) biosynthesis inhibitor, in anaesthetized rats. In contrast, neither splanchnectomy nor guanethidine (5 mg kg(-1)) had an effect. 3. An intravenous (I.V.) infusion of D-glucose (20 %) for 30 min, which increased blood glucose concentrations from 5.4 to 12.8 mM, significantly inhibited gastric distension-induced pyloric relaxation. 4. An intracerebroventricular (I.C.V.) injection of D-glucose (3 micromol) also significantly inhibited gastric distension-induced pyloric relaxation without affecting peripheral blood glucose concentrations. 5. I.V. infusion of D-glucose significantly elevated hypothalamic neuropeptide Y (NPY) concentrations. 6. Intracerebroventricular (I.C.V.) administration of NPY (0.03--3 nmol) and a Y1 receptor agonist, [leu(31), pro(34)] NPY (0.03--3 nmol), significantly inhibited gastric distension-induced pyloric relaxation in a dose-dependent manner. 7. I.C.V. administration of a Y1 receptor antagonist, BIBP 3226 (30 nmol), and of a NPY antibody (titre 1:24 000, 3 microl) abolished the inhibitory effects of hyperglycaemia on gastric distension-induced pyloric relaxation. 8. Taken together, these findings suggest that gastric distension-induced pyloric relaxation is mediated via a vago-vagal reflex and NO release. Acute hyperglycaemia stimulates hypothalamic NPY release, which, acting through the Y1 receptor, inhibits gastric distension-induced pyloric relaxation in rats exposed to acute elevations in blood glucose concentrations. PMID:11410636

Ishiguchi, T; Nakajima, M; Sone, H; Tada, H; Kumagai, A K; Takahashi, T

2001-06-15

149

Ipsilaterality of Motor Innervation of Canine Urethral Sphincter  

Microsoft Academic Search

The functional activity of the sphincter muscle of the urethra is known to be controlled largely by the hypogastric and pudendal nerves. It remains unknown, however, whether innervation of the muscle by these peripheral nerves is ipsi- or bilateral. In an attempt to answer this question urethral closure pressure was determined simultaneously in the anterior, posterior, right and left portions

Takashi Morita; Norihisa Kizu; Shun Kondo; Shinobu Dohkita; Seigi Tsuchida

1988-01-01

150

Electroacupuncture may relax the sphincter of Oddi in humans  

Microsoft Academic Search

Background: This study was designed to evaluate the effects of electroacupuncture on sphincter of Oddi (SO) motility in humans and to associate the manometric findings with cholecystokinin (CCK) plasma levels. Methods: Eleven patients (M:F = 5:6) with various kinds of biliary disorders were enrolled. SO motility was monitored with conventional low-compliance, continuous perfusion technique at ERCP (n = 9) or

Sung-Koo Lee; Myung-Hwan Kim; Hong-Ja Kim; Dong-Wan Seo; Kyo-Sang Yoo; Yun-Ho Joo; Young-Il Min; Ji-Hoon Kim; Byung-Il Min

2001-01-01

151

Laparoscopic transcystic duct balloon dilatation of the sphincter of Oddi  

Microsoft Academic Search

Balloon dilatation of the sphincter of Oddi has been performed via a laparoscopic transcystic duct technique. Small common duct stones and stone debris have been successfully lavaged into the duodenum in 17 of 20 cases (85%) by this method. Postoperative hyperamylasemia was noted in four patients. Mild clinical pancreatitis was observed in three patients (15%). Further evaluation of this technique

B. J. Carroll; E. H. Phillips; M. Chandra; M. Fallas

1993-01-01

152

Effect of lateral sphincterotomy on internal anal sphincter function  

Microsoft Academic Search

PURPOSE: This study was designed to investigate the effect of lateral sphincterotomy on internal anal sphincter function in patients with chronic anal fssure. METHODS: Using an eight-channel perfusion catheter and computerized data analysis, a prospective manometric study was performed on patients with chronic anal fissure undergoing lateral sphincterotomy (LS). RESULTS: Mean resting pressure (MRP) in patients with anal fissure (85.1

N. Williams; N. A. Scott; M. H. Irving

1995-01-01

153

Non-sphincter splitting fistulectomy vs conventional fistulotomy for high trans-sphincteric fistula-in-ano: a prospective functional and manometric study  

Microsoft Academic Search

Purpose  This study compared the clinical and physiological results of non-sphincter splitting fistulectomy (N-SSF) with those of sphincter\\u000a splitting fistulotomy (SSF) for treatment of high trans-sphincteric fistula-in-ano.\\u000a \\u000a \\u000a \\u000a Materials and methods  A prospective, observational study was undertaken in 70 consecutive patients with high trans-sphincteric fistula treated by\\u000a SSF (n?=?35) or N-SSF (n?=?35). Anal manometry was performed before and 3 months after surgery. Anal continence

Takayuki Toyonaga; Makoto Matsushima; Yoshiaki Tanaka; Kazunori Suzuki; Nobuhito Sogawa; Hiroki Kanyama; Yasuhiro Shimojima; Tomoaki Hatakeyama; Masao Tanaka

2007-01-01

154

Effects of the Temporary Placement of a Self-Expandable Metallic Stent in Benign Pyloric Stenosis  

PubMed Central

Background/Aims The use of self-expandable metallic stents (SEMS) is an established palliative treatment for malignant stenosis in the gastrointestinal tract; therefore, its application to benign stenosis is expected to be beneficial because of the more gradual and sustained dilatation in the stenotic portion. We aimed in this prospective observational study to evaluate the efficacy and safety of temporary SEMS placement in benign pyloric stenosis. Methods Twenty-two patients with benign stenosis of the prepylorus, pylorus, and duodenal bulb were enrolled and underwent SEMS placement. We assessed symptom improvement, defined as an increase of at least 1 degree in the gastric-outlet-obstruction scoring system after stent insertion. Results No major complications were observed during the procedures. After stent placement, early symptom improvement was achieved in 18 of 22 patients (81.8%). During the follow-up period (mean 10.2 months), the stents remained in place successfully for 6 to 8 weeks in seven patients (31.8%). Among the 15 patients (62.5%) with stent migration, seven (46.6%) showed continued symptomatic improvement without recurrence of obstructive symptoms. Conclusions Despite the symptomatic improvement, temporary SEMS placement is premature as an effective therapeutic tool for benign pyloric stenosis unless a novel stent is developed to prevent migration.

Choi, Won Jae; Park, Jain; Lim, Eun-Hye; Joo, Moon Kyung; Yun, Jae-Won; Noh, Hyejin; Kim, Sung Ho; Choi, Woo Seok; Lee, Beom Jae; Kim, Ji Hoon; Yeon, Jong Eun; Kim, Jae Seon; Byun, Kwan Soo; Bak, Young-Tae

2013-01-01

155

Histological description of the midgut and the pyloric valve of Tropidacris collaris (Stoll, 1813) (Orthopetera: Romaleidae).  

PubMed

The present research describes the histology of the midgut, gastric caeca, and pyloric valve of Tropidacris collaris (Stoll, 1813), (Orthopetera: Romaleidae). We used light microscopy, staining (Gomori's trichrome and periodic acid-Schiff (PAS)), and a routine histological analysis method (hematoxilin-eosin). The insects were obtained from, and also bred in, the Laboratory of Entomology, Department of Biology, of the Rural Federal University of Pernambuco (UFRPE). The collected material was fixed in alcoholic Botüin and embedded in paraplast. The results demonstrated that the midgut wall is composed of an inner epithelial layer and two outer layers of striate muscles: one internal (circular) and the other external (longitudinal), with connective tissue between the muscle fibers. The epithelium is single-layered, with two cell types: regenerative and elongated columnar. The gastric caeca presents muscle layers similar to those of the midgut. Simple columnar epithelium lines the gastric caeca, which presents villi and projects towards the lumen. The pyloric valve is of striate muscle tissue, covered by a single epithelial-cell layer. PMID:17299940

Wanderley-Teixeira, V; Teixeira, A A C; Cunha, F M; Costa, M K C M; Veiga, A F S L; Oliveira, J V

2006-11-01

156

Pyloric giant Brunner's gland hamartoma as a cause of both duodenojejunal intussusception and obscure gastrointestinal bleeding.  

PubMed

Obscure gastrointestinal bleeding is an important dilemma. Brunner's gland hamartoma is an extremely rare tumor generally localized in the duodenal bulb. We present a 34-year-old woman who had suffered from several episodes of melena for the past three years. Endoscopic examinations were normal. Computed tomography showed a large target lesion over the right abdomen and an image representing intestinal malrotation, which was supported by enteroclysis. At exploratory laparotomy, ligamentum of Treitz was located in the mid-to-right side of the columna vertebralis, and the duodenal bulb was found to be invaginated into the proximal jejunum. After longitudinal duodenotomy, a pedunculated ring-shaped large polyp originating from the pyloric ring was seen and excised. Histology was consistent with Brunner's gland hamartoma. This case with obscure bleeding was original with respect to its rarity and being a huge, ring-shaped tumor with pyloric localization. Moreover, the patient had a rare clinical presentation of duodenojejunal intussusception with accompanying intestinal malrotation. PMID:19330736

Bayan, Kadim; Tüzün, Yekta; Yilmaz, Serif; Yilmaz, Gül?en; Bilici, Aslan

2009-03-01

157

Changes in gastric myoelectrical activity in hypertrophic pyloric stenosis and after surgical correction.  

PubMed

The changes of gastric myoelectrical activity were investigated in 20 infants by cutaneous electrogastrography (EGG) before and after the surgical correction of infantile hypertrophic pyloric stenosis (IHPS). The dominance of 2-4 cycles per minute (CPM) "slow waves" is typical of the healthy gastric function. The shift of the dominant frequencies towards the slower frequency (0-2 CPM) is defined as bradygastria, whereas a shift towards the more frequent waves (4-10 CPM) is called tachygastria. Unlike with healthy infants, the electrogastrogram showed pathologic patterns in 85% (18 out of 20) of IHPS patients. In all except two of these infants with pathologic electrical patterns, the frequency of the waves significantly shifted towards tachygastria. The effect of feeding on the gastric myoelectrical activity could only be studied in limited (9/20) cases because of recurring vomiting during the preoperative period. In IHPS infants, a significant increase in the bradygastria group was observed in the postprandial period compared with healthy infants. Three to 5 days after surgical repair (pyloromyotomy) and the reintroduction of feeding in gradually increasing amounts, the gastric myoelectrical activity showed physiologic patterns again, showing that the pyloric function was back to normal. Cutaneous EGG is a useful, noninvasive method to obtain indirect information about the motor function of the stomach and might be further applicable to pediatric gastric motility disorders. PMID:15179517

Bókay, J; Kis, E; Verebély, T

2004-05-01

158

When is Onuf's nucleus involved in multiple system atrophy? A sphincter electromyography study  

PubMed Central

Background: External anal sphincter (EAS) electromyography (EMG) abnormalities can distinguish multiple system atrophy (MSA) from Parkinson's disease in the first five years after disease onset. However, the prevalence of the abnormalities in the early stages of MSA is unknown. Objectives: To present EAS-EMG data in the various stages of MSA. Methods: 84 patients with "probable" MSA were recruited (42 men, 42 women; mean age 62 years (range 47 to 78); mean disease duration 3.2 years (0.5 to 8.0; <1 year in 25%); 50 cerebellar form (MSA-C), 34 parkinsonian form (MSA-P)). EAS motor unit potential (MUP) analysis and EMG cystometry were carried out in all patients. Results: The overall prevalence of neurogenic change of the EAS MUP was 62%—52% in the first year after disease onset, increasing to 83% by the fifth year (p<0.05); it also increased with severity of gait disturbance (p<0.05), storage and voiding disorders, and detrusor sphincter dyssynergy (NS). The neurogenic change was not correlated with sex, age, MSA-P/C, postural hypotension, constipation, erectile dysfunction in men, underactive or acontractile detrusor, or detrusor overactivity. In 17 incontinent patients without detrusor overactivity or low compliance, urinary incontinence was more severe in those with neurogenic change than in those without (p<0.05). Conclusions: Involvement of Onuf's nucleus in MSA is time dependent. Before the fifth year of illness, the prevalence of neurogenic change does not seem to be high, so a negative result cannot exclude the diagnosis of MSA.

Yamamoto, T; Sakakibara, R; Uchiyama, T; Liu, Z; Ito, T; Awa, Y; Yamamoto, K; Kinou, M; Yamanishi, T; Hattori, T

2005-01-01

159

Does surgery correct esophageal motor dysfunction in gastroesophageal reflux.  

PubMed Central

The high incidence of dysphagia in patients with symptomatic gastroesophageal reflux (GER) but no evidence of peptic stricture suggests esophageal motor dysfunction. Conventional methods for detecting dysfunction (radiologic and manometric examinations) often fail to detect abnormality in these patients. Radionuclide transit (RT), a new method for detecting esophageal motor dysfunction, was used to prospectively assess function in 29 patients with symptomatic GER uncomplicated by stricture before and three months after antireflux surgery (HILL). The preoperative incidence of dysphagia and esophageal dysfunction was 73% and 52%, respectively. During operation (Hill repair), intraoperative measurement of the lower esophageal sphincter pressure was performed and the LESP raised to levels between 45 and 55 mmHg. The preoperative lower esophageal sphincter pressure was raised from a mean of 8.6 mmHg, to mean of 18.5 mmHg after operation. No patient has free reflux after operation. Postoperative studies on 20 patients demonstrated persistence of all preoperative esophageal dysfunction despite loss of dysphagia. RT has demonstrated a disorder of esophageal motor function in 52% of patients with symptomatic GER that may be responsible for impaired esophageal clearance. This abnormality is not contraindication to surgery. The results indicate that construction of an effective barrier to reflex corrects symptoms of reflux, even in the presence of impaired esophageal transit. Radionuclide transit is a safe noninvasive test for assessment of esophageal function.

Russell, C O; Pope, C E; Gannan, R M; Allen, F D; Velasco, N; Hill, L D

1981-01-01

160

Starvation and refeeding effects on pyloric caeca structure of Caspian salmon (Salmo trutta caspius, Kessler 1877) juvenile.  

PubMed

Effect of starvation and refeeding on the structure of pyloric caeca was studied in the juveniles of Caspian Sea salmon. Juveniles (average body weight 12±0.1g) were subjected to four levels of feeding: full-fed for 6 weeks (FFF), 3 weeks fed and 3 weeks following starvation (FS), 3 weeks starved and 3 weeks fed (SF), and full-starved (SSS) for 6 weeks. Light microscopic studies showed significant reduction (p<0.05) in the enterocytes height and number, villus length, epithelial area and pyloric caeca total area in starved groups as compared to control group. These reductions were more significant (p<0.05) in long term starved group (SSS) than short term starved group (FS). Additionally, refeeding increased pyloric caeca size and enterocyte's number in SF group whereas, the epithelial total area and villus length did not reach the same area and length as control group. Results indicated that in Caspian Sea salmon juveniles food deprivation and consuming of food source, adversely affected the tissue of pyloric caeca while refeeding can be effective on healing tissue damage. PMID:23477933

Emadi Shaibani, Mina; Mojazi Amiri, Bagher; Khodabandeh, Saber

2013-06-01

161

Genotoxicity and cell proliferative activity of a nitrosated Oroxylum indicum Vent fraction in the pyloric mucosa of rat stomach.  

PubMed

In vivo genotoxic activity and cell proliferative activity were examined in the stomach mucosa of male F344 rats by in vivo short-term methods after oral administration of a nitrosated Oroxylum indicum Vent (OiV) fraction, which had been found to be mutagenic without S9 mix to Salmonella typhimurium TA98 and TA100. Administration of the nitrosated OiV fraction at doses of 1 and 2 g/kg body weight induced dose-dependent DNA single-strand scission (p less than 0.02), determined by the alkaline elution method, in the stomach pyloric mucosa 2 h after its administration: a dose of 2 g/kg body weight induced an 18-fold increase in the DNA elution rate constant. Administration of the nitrosated OiV fraction at doses of 0.7-2.8 g/kg body weight also induced dose-dependent increases, up to 11-fold (p less than 0.05), in replicative DNA synthesis in the stomach pyloric mucosa 16 h after its administration. Moreover administration of the nitrosated OiV fraction at doses of 0.25-2.0 g/kg body weight induced dose-dependent increases, up to 100-fold, in ornithine decarboxylase activity in the stomach pyloric mucosa with a maximum 4 h after its administration. These results demonstrate that the nitrosated OiV fraction has genotoxic and cell proliferative activity in the pyloric mucosa of rat stomach in vivo. PMID:1371592

Tepsuwan, A; Furihata, C; Rojanapo, W; Matsushima, T

1992-01-01

162

Erectile Dysfunction  

MedlinePLUS Videos and Cool Tools

... penis becomes soft or flaccid. Testosterone is a sex hormone secreted by the testicles, and is important ... dysfunction is caused by psychological reasons, counseling or sex therapy may be recommended. This document is for ...

163

Pyloric Stenosis  

MedlinePLUS

... condition that may affect the gastrointestinal tract during infancy, isn't normal — it can cause your baby ... the more common causes of intestinal obstruction during infancy that requires surgery. Causes It is believed that ...

164

Effects of morphine on the human sphincter of Oddi  

Microsoft Academic Search

The effects of morphine on intraluminal pressures recorded from the sphincter of Oddi (SO) at endoscopic retrograde cholangiopancreatography in 19 patients who were without evidence of biliary or pancreatic disease were studied. Morphine was given in four successive doses of 2.5, 2.5, 5, and 10 micrograms\\/kg iv at five minute intervals. Morphine in subanalgesic doses increased the frequency of SO

J F Helm; R P Venu; J E Geenen; W J Hogan; W J Dodds; J Toouli; R C Arndorfer

1988-01-01

165

Whole stomach with antro-pyloric nerve preservation as an esophageal substitute: an original technique.  

PubMed

The paper describes an original technique of gastric tailoring in which the two-thirds of the lesser curvature proximal to the crow's foot are denuded flush with the gastric wall, leaving both nerves of Latarjet and the hepatic branches of the left vagus nerve intact. Maintenance of the vagal supply to the antro-pyloric segment in two patients resulted in the presence of peristaltic contractions sweeping over the antrum on simple observation of the antral wall at the end of the procedure and on both upper G-I series and intragastric manometry tracings 6 weeks postoperatively. Gastric exposure to bile on 24-h gastric bile monitoring was normal 6 weeks after the operation. Neither patient had any gastrointestinal symptoms with the exception of early sensations of postprandial fullness when overeating. PMID:15230732

Collard, J-M; Romagnoli, R; Goncette, L; Gutschow, C

2004-01-01

166

Temperature Sensitivity of the Pyloric Neuromuscular System and Its Modulation by Dopamine  

PubMed Central

We report here the effects of temperature on the p1 neuromuscular system of the stomatogastric system of the lobster (Panulirus interruptus). Muscle force generation, in response to both the spontaneously rhythmic in vitro pyloric network neural activity and direct, controlled motor nerve stimulation, dramatically decreased as temperature increased, sufficiently that stomach movements would very unlikely be maintained at warm temperatures. However, animals fed in warm tanks showed statistically identical food digestion to those in cold tanks. Applying dopamine, a circulating hormone in crustacea, increased muscle force production at all temperatures and abolished neuromuscular system temperature dependence. Modulation may thus exist not only to increase the diversity of produced behaviors, but also to maintain individual behaviors when environmental conditions (such as temperature) vary.

Thuma, Jeffrey B.; Hobbs, Kevin H.; Burstein, Helaine J.; Seiter, Natasha S.; Hooper, Scott L.

2013-01-01

167

[Personal experience with ultrasonic diagnosis of hypertrophic pyloric stenosis in infants].  

PubMed

Until wide use of ultrasound in diagnostic procedures took its part, the only relevant procedures to diagnose Infantile Hypertrophic Pyloric Stenosis (IHPS) were clinical examination and X-ray of gastroduodenal tract. Use of diagnostic ultrasound avoids harmful effects of X-rays on immature children's tissues. Reliability of the procedure is very high. In the period between July 1993 and January 1999 we diagnosed 12 cases of IHPS in our Hospital by ultrasound examinations. Eleven patients were males between five and eight weeks of age, and one female was six weeks old. In six of them the finding was confirmed by radiological examination (on surgeon's request), in one neither radiological examination not surgery was performed, and five were operated on the basis of only ultrasound finding. In eleven operated patients ultrasound finding is proven by surgery. PMID:10573956

Sari?, G; Simuni?, S; Pinoti?, L; Rupci?, B

1999-01-01

168

Infantile hypertrophic pyloric stenosis: a study of feeding practices and other possible causes.  

PubMed Central

We carried out a case-control study of the hospital charts of 91 infants with infantile hypertrophic pyloric stenosis (IHPS) to determine the feeding practices at the time of discharge from the neonatal nursery. We excluded infants whose feeding might have been influenced by confounding factors. The infants were matched with controls for gestational age. The mean birth weight of the IHPS group was 3501 g and of the control group 3543 g. The male:female ratio for the IHPS group was 5.5. The odds ratio of male predominance was 4. We found that bottle-feeding was 2.9 times more prevalent among the infants with IHPS than among the control subjects. We speculate that the recently observed decrease in the incidence of IHPS is due to the decline in bottle-feeding.

Habbick, B F; Khanna, C; To, T

1989-01-01

169

Urofacial syndrome: A subset of neurogenic bladder dysfunction syndromes?  

PubMed Central

The urofacial syndrome is probably a subset of neurogenic bladder dysfunction syndromes characterized by detrusor-sphincter discoordination along with a characteristic inversion of facial expression with laughing. This characteristic facial expression can facilitate early detection of this disorder, which leads to poor bladder emptying with high residual urine, hydro-nephrosis with vesico-ureteral reflux and potentially renal failure if left untreated. The etiology of the urofacial syndrome is unknown. In our case, a 12-year-old boy of Middle-Eastern origin presented to the Outpatient Department of our hospital with left pyelonephritis, hydronephrosis and bladder dilatation. Voiding cystourethrography performed 15 days later revealed left vesicoureteral reflux. Cystoscopy revealed bladder trabeculation however an anatomic urethral obstruction was not noticed. Both, neurological examination and radiography of the lumbosacral spine were normal. Urodynamic evaluation revealed the typical findings of detrusor-sphincter discoordination.

Stamatiou, K. N.; Karakos, C. D.

2010-01-01

170

Ejaculatory dysfunction.  

PubMed

Ejaculatory dysfunction may occur after many different disorders ranging from traumatic spinal cord injury to diabetes mellitus. With an understanding of the many facets and nuances of the ejaculatory apparatus, both anatomic and neurologic, the well-versed clinician can proceed along a safe, efficient, and appropriate treatment algorithm to help affected men and their partners achieve parenthood. PMID:24286771

Phillips, Elizabeth; Carpenter, Christina; Oates, Robert D

2014-02-01

171

Monitoring of pharyngeal and upper esophageal sphincter activity with an arterial dilation balloon catheter.  

PubMed

In patients with dysphagia and radiologic signs of dysfunction of the upper esophageal sphincter (UES), manometry is helpful in giving a better understanding of muscular activity during swallowing. Traditional manometric methods include use of perfusion catheters or solid-state intraluminal strain gauges. The rapid and asymmetric pressure variations in the UES and difficulties compensating for the pharyngolaryngeal elevation during swallowing limit the value of these methods. We used an arterial balloon dilation catheter as a probe in manometric recording of the UES in 28 healthy volunteers. Simultaneous perfusion manometry of the pharynx with the same catheter was performed to assess the coordination of the muscular activity in the esophageal entrance during swallowing. The catheter was well tolerated by all subjects. We found an average resting pressure in the UES of 31.0 mmHg, and the average maximum pressure during contraction was 89.0 mmHg. The average duration of the swallowing act was 3.9 s. All subjects displayed a complete UES relaxation and a normal coordination of propagated pressure in the hypopharynx and UES. The results were highly reproducible and the interindividual range was low. Arterial dilation catheters are safe and have suitable physical properties for pressure monitoring in the UES. PMID:17294301

Lindén, Mats; Högosta, Sture; Norlander, Tomas

2007-04-01

172

[Clinical evaluation of covered self-expandable metallic stent for unresectable malignant stomach pyloric region and duodenal obstruction].  

PubMed

We evaluated palliative treatment for unresectable malignant stomach pyloric region and the duodenal obstruction using covered self-expandable metallic stent (SEMS). Fifty-seven patients (26 stomach pyloric stenosis, 31 duodenal stenosis) were underwent palliative treatment using covered SEMS. The covered SEMS was Ultraflex stent for esophageal obstruction. The covered SEMS was successfully indwelled in the target region in 56 patients. The patients became able to ingest orally after a mean of 2 days, and 96% of the patients (54/56) became able to eat solid or semi-solid diets later. The SEMS obstruction by tumor ingrowth or hyperplasia was not occurred, so SEMS was maintenance-free. We concluded covered SEMS was useful palliative treatment because it prevented SEMS obstruction by tumor ingrowth or hyperplasia and it was maintenance-free. PMID:16629459

Hayashi, Kazuki; Okayama, Yasutaka; Ueno, Kouichiro; Miyabe, Katsuyuki; Naitoh, Itaru; Hirai, Masaaki; Kitajima, Yasuhiro; Ban, Tesshin; Gotoh, Kazuo; Yamada, Tomonori; Sano, Hitoshi; Nakazawa, Takahiro; Ohara, Hirotaka; Joh, Takashi; Itoh, Makoto

2006-04-01

173

Comparative anti-ulcerogenic study of pantoprazole formulation with and without sodium bicarbonate buffer on pyloric ligated rat  

PubMed Central

Objective: To compare the anti-ulcer activity of buffered pantoprazole tablet against plain pantoprazole in pyloric ligated rats. Materials and Methods: In vivo pyloric ligated ulcerogenesis model was used to assess the effect of buffered pantoprazole on the volume of the gastric content, pH, total and free acidity, and ulcerogenic lesion. Pantoprazole level in gastric content and concurrently in stomach tissue was assessed by High Performance Liquid Chromatography (HPLC) analysis. Results: Buffered tablet effectively increases the pH of the gastric content above 4 up to 6 h (P<0.001) protecting pantoprazole from acid degradation resulting in high concentration in the gastric content and stomach tissue. Conclusions: This study substantiates better, faster and prolonged bioavailability of pantoprazole-buffered tablet compared to plain pantoprazole.

Bigoniya, Papiya; Shukla, A.; Singh, C. S.; Gotiya, P.

2011-01-01

174

Roles of sphincter of Oddi motility and serum vasoactive intestinal peptide, gastrin and cholecystokinin octapeptide  

PubMed Central

AIM: To investigate roles of sphincter of Oddi (SO) motility played in pigment gallbladder stone formation in model of guinea pigs. METHODS: Thirty-four adult male Hartley guinea pigs were divided randomly into two groups: the control group and pigment stone group. The pigment stone group was divided into 4 subgroups with 6 guinea pigs each according to time of sacrifice, and were fed a pigment lithogenic diet and sacrificed after 3, 6, 9 and 12 wk. SO manometry and recording of myoelectric activity of the guinea pigs were obtained by multifunctional physiograph at each stage. Serum vasoactive intestinal peptide (VIP), gastrin and cholecystokinin octapeptide (CCK-8) were detected at each stage in the process of pigment gallbladder stone formation by enzyme-linked immunosorbent assay. RESULTS: The incidence of pigment gallstone formation was 0%, 0%, 16.7% and 66.7% in the 3-, 6-, 9- and 12-wk group, respectively. The frequency of myoelectric activity decreased in the 3-wk group. The amplitude of myoelectric activity had a tendency to decrease but not significantly. The frequency of the SO decreased significantly in the 9-wk group. The SO basal pressure and common bile duct pressure increased in the 12-wk group (25.19 ± 7.77 mmHg vs 40.56 ± 11.81 mmHg, 22.35 ± 7.60 mmHg vs 38.51 ± 11.57 mmHg, P < 0.05). Serum VIP was significantly elevated in the 6- and 12-wk groups and serum CCK-8 was decreased significantly in the 12-wk group. CONCLUSION: Pigment gallstone-causing diet may induce SO dysfunction. The tension of the SO increased. The disturbance in SO motility may play a role in pigment gallstone formation, and changes in serum VIP and CCK-8 may be important causes of SO dysfunction.

Zhang, Zhen-Hai; Qin, Cheng-Kun; Wu, Shuo-Dong; Xu, Jian; Cui, Xian-Ping; Wang, Zhi-Yi; Xian, Guo-Zhe

2014-01-01

175

Purification and characterization of phospholipase A2 from the pyloric caeca of red sea bream, Pagrus major  

Microsoft Academic Search

A phospholipase A2 was purified 55,000-fold in a yield of 10% from the lipid-free extract of powder of the pyloric caeca of red sea bream to near homogeneity by sequential column chromatography on S-sepharose fast flow, butyl-cellulofine, Asahipak ES-502C cation-exchange HPLC, TSK gel G3000SW gel-filtration HPLC, and Asahipak ODP-50 reversed-phase HPLC. The final preparation showed a single band with the

N. Iijima; S. Chosa; K. Uematsu; T. Goto; T. Hoshita; M. Kayama

1997-01-01

176

Comparative study on the proteases from fish pyloric caeca and the use for production of gelatin hydrolysate with antioxidative activity  

Microsoft Academic Search

Proteases from pyloric caeca extract of three fish species including brownstripe red snapper (Lutjanus vitta), bigeye snapper (Priacanthus tayenus) and threadfin bream (Nemipterus marginatus) were comparatively studied. The extracts from bigeye snapper and threadfin bream exhibited the highest hydrolytic activities toward casein, ?-N-benzoyl-dl-arginine-p-nitroanilide and ?-N-?-tosyl-l-arginine methyl ester at pH 8.0 and 60 °C and pH 8.5 and 55 °C, respectively. The extract

Sutheera Khantaphant; Soottawat Benjakul

2008-01-01

177

Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction  

PubMed Central

Nonrelaxing pelvic floor dysfunction is not widely recognized. Unlike in pelvic floor disorders caused by relaxed muscles (eg, pelvic organ prolapse or urinary incontinence, both of which often are identified readily), women affected by nonrelaxing pelvic floor dysfunction may present with a broad range of nonspecific symptoms. These may include pain and problems with defecation, urination, and sexual function, which require relaxation and coordination of pelvic floor muscles and urinary and anal sphincters. These symptoms may adversely affect quality of life. Focus on the global symptom complex, rather than the individual symptoms, may help the clinician identify the condition. The primary care provider is in a position to intervene early, efficiently, and effectively by (1) recognizing the range of symptoms that might suggest nonrelaxing pelvic floor dysfunction, (2) educating patients, (3) performing selective tests when needed to confirm the diagnosis, and (4) providing early referral for physical therapy.

Faubion, Stephanie S.; Shuster, Lynne T.; Bharucha, Adil E.

2012-01-01

178

Erectile Dysfunction  

Microsoft Academic Search

\\u000a Erectile dysfunction (ED) is defined as the consistent inability to achieve or maintain an erection. This may affect around\\u000a 50% of men between the ages of 40 and 70, while persistent ED affects about 5% of men in their 40s, and 15–25% of men by the\\u000a age of 65 [1]. As life expectancy increases, the incidence of ED is expected

Chi-Ying Li; David Ralph

179

[Erectile dysfunction].  

PubMed

In Spain, based on the IIEF, 19% of males between 25 and 70 years old present some degree of erectile dysfunction (ED). Therefore, around 2,000,000 Spanish men present this condition and could require medical attention for it. Here, we present an up-date of the most important aspects of erectile dysfunction (pathophysiology, diagnosis and treatment). We review, in detail, the oral treatments and future drugs that are presently in the premarketing experimental phase. Diagnostic and therapeutic management of the patient with erectile dysfunction should be individualized, taking into account the goals of each patient. It is highly recommendable to carry out a basic assessment (comprehensive clinical history, physical examination, recommended lab testing). If previously undiagnosed diseases are discovered (diabetes, arteriosclerosis, etc.) these should be treated and modifiable risk factors should be corrected. There are numerous therapeutic options for the treatment of erectile dysfunction. Replacement therapy with testosterone should only be used in males with ED and low levels of this hormone, under medical supervision. At present, first line treatment consists of the administration of oral drugs (sildenafil, apomorphine). There are two new PDE 5 inhibitors (tadalafil and vardenafil) that will be released on the market 2003, which will provide better selectivity. Moreover, several drugs for oral administration are in the initial phases of research that will facilitate erection via a direct penile action. When oral drugs are contraindicated, are not effective or when they are unpopular with the patient, the second line of treatment is intracavernous injection. Prostaglandin E1 is the initial drug of choice in patients using intracavernous autoinjection for the first time and has a high efficacy. Implantation of a penis prosthesis and penile revascularisation are appropriate for highly selected patients. Psychotherapy can be an option for men with ED of psychogenic origin, either as a monotherapy or combined with sildenafil or apomorphine. PMID:12508460

Rodríquez Vela, L; Gonzalvo Ibarra, A; Pascual Regueiro, D; Rioja Sanz, L A

2002-10-01

180

Investigation of cholecystokinin receptors in the human lower esophageal sphincter  

PubMed Central

AIM: To compare the binding of cholecystokinin (CCK)-8 to CCK receptors in sling and clasp fibers of the human lower esophageal sphincter. METHODS: Esophageal sling and clasp fibers were isolated from eight esophagectomy specimens, resected for squamous cell carcinoma in the upper two thirds of the esophagus, which had been maintained in oxygenated Kreb’s solution. Western blot was used to measure CCK-A and CCK-B receptor subtypes in the two muscles. A radioligand binding assay was used to determine the binding parameters of 3H-CCK-8S to the CCK receptor subtypes. The specificity of binding was determined by the addition of proglumide, which blocks the binding of CCK to both receptor subtypes. RESULTS: There was no significant difference between the sling and clasp fibers of the human lower esophageal sphincter in the amount of CCK-A [integrated optical density (IOD) value: 22.65 ± 0.642 vs 22.328 ± 1.042, P = 0.806] or CCK-B receptor protein (IOD value: 13.20 ± 0.423 vs 12.45 ± 0.294, P = 0.224) as measured by Western blot. The maximum binding of radio-labeled CCK-8S was higher in the sling fibers than in the clasp fibers (595.75 ± 3.231 cpm vs 500.000 ± 10.087 cpm, P < 0.001) and dissociation constant was lower (Kd: 1.437 ± 0.024 nmol/L vs 1.671 ± 0.024 nmol/L, P < 0.001). The IC50 of the receptor specific antagonists were lower for the CCK-A receptors than for the CCK-B (P < 0.01). CONCLUSION: CCK binding modulates the contractile function of the lower esophageal sphincter through differential binding to the CCK-A receptor on the sling and clasp fibers.

Liu, Jun-Feng; Zhang, Jian; Liu, Xin-Bo; Drew, Paul A

2014-01-01

181

Characterization of the Upper Esophageal Sphincter Response During Cough  

PubMed Central

Background: Vagal reflex initiated by esophageal stimulation and microaspiration can cause chronic cough in patients with gastroesophageal reflux disease (GERD). By raising intraabdominal pressure, cough can, in turn, predispose to GERD. The role of the upper esophageal sphincter (UES) in preventing esophagopharyngeal reflux during coughing is not well known. The aim of this study was to evaluate the UES response during coughing. Methods: We studied 20 healthy young (10 women; age, 27 ± 5 years) and 15 healthy elderly (nine women; age, 73 ± 4 years) subjects. Hard and soft cough-induced pressure changes in the UES, distal esophagus, lower esophageal sphincter, and stomach were determined simultaneously using high-resolution manometry and concurrent acoustic cough recordings. Results: Resting UES pressure was significantly higher in the young compared with the elderly subjects (42 ± 14 mm Hg vs 24 ± 9 mm Hg; P < .001). Cough induced a UES contractile response in all subjects. Despite lower UES resting pressures in the elderly subjects, the maximum UES pressure during cough was similar between the young and the elderly subjects (hard cough, 230 ± 107 mm Hg vs 278 ± 125 mm Hg, respectively; soft cough, 156 ± 85 mm Hg vs 164 ± 119 mm Hg, respectively; P not significant for both). The UES pressure increase over baseline during cough was significantly higher than that in the esophagus, lower esophageal sphincter, and stomach for both groups (P < .001). Conclusions: Cough induces a rise in UES pressure, and this response is preserved in elderly people. A cough-induced rise in UES pressure is significantly higher than that in the esophagus and stomach, thereby providing a barrier against retrograde entry of gastric contents into the pharynx.

Amaris, Manuel; S. Dua, Kulwinder; Naini, Sohrab Rahimi; Samuel, Erica

2012-01-01

182

Role of bottle feeding in the etiology of hypertrophic pyloric stenosis.  

PubMed

IMPORTANCE Bottle feeding has been implicated in the etiology of hypertrophic pyloric stenosis (HPS). Further data are needed to define the nature of this relationship and the clinical variables that influence it. OBJECTIVE To determine if bottle feeding after birth is associated with the development of HPS in infants. We hypothesized that bottle feeding is associated with an increased risk of HPS and that this risk is modified by other risk factors. DESIGN, SETTING, AND PARTICIPANTS Population-based case-control study of births from January 1, 2003, to December 31, 2009, using Washington State birth certificates linked to hospital discharge data. Cases included all singleton infants born within the study period and subsequently admitted with both a diagnostic code for HPS and a procedure code for pyloromyotomy (n?=?714). Controls were randomly chosen among singleton infants who did not develop HPS and were frequency matched to cases by birth year. EXPOSURE Feeding status (breast vs bottle) was coded on the birth certificate as the type of feeding the infant was receiving at birth discharge. MAIN OUTCOME AND MEASURE Diagnosis of HPS. RESULTS Hypertrophic pyloric stenosis incidence decreased over time, from 14 per 10,000 births in 2003 to 9 per 10,000 in 2009. Simultaneously, breastfeeding prevalence increased from 80% in 2003 to 94% in 2009. Compared with controls, cases were more likely to be bottle feeding after birth (19.5% vs 9.1%). After adjustment, bottle feeding was associated with an increased risk of HPS (odds ratio [OR], 2.31; 95% CI, 1.81-2.95). This association did not differ according to sex or maternal smoking status but was significantly modified by maternal age (<20 years OR, 0.98; 95% CI, 0.51-1.88; ?35 years OR, 6.07; 95% CI, 2.81-13.10) and parity (nulliparous OR, 1.60; 95% CI, 1.07-2.38; multiparous OR, 3.42; 95% CI, 2.23-5.24). CONCLUSIONS AND RELEVANCE Bottle feeding is associated with an increased risk of HPS, and this effect seems to be most important in older and multiparous women. These data suggest that bottle feeding may play a role in HPS etiology, and further investigations may help to elucidate the mechanisms underlying the observed effect modification by age and parity. PMID:24146084

McAteer, Jarod P; Ledbetter, Daniel J; Goldin, Adam B

2013-12-01

183

Nissen fundoplication has a vagolytic effect on the lower esophageal sphincter  

Microsoft Academic Search

Background: Laparoscopic Nissen fundoplication is an increasingly utilized option for the treatment of gastroesophageal reflux disease (GERD). However, many questions remain as to the mechanism by which this operation prevents GERD in those without hiatal hernias or incompetent lower esophageal sphincters (LES). It is known that these patients experience reflux due to excess transient lower esophageal sphincter relaxations (TLESR), inappropriate

B. Sarani; T. Chan; R. Wise; S. Evans

2003-01-01

184

Urethral sphincter EMG-controlled dorsal penile\\/clitoral nerve stimulation to treat neurogenic detrusor overactivity  

Microsoft Academic Search

The goal of this study was to investigate whether real-time external urethral sphincter (EUS) EMG-controlled dorsal genital nerve (DGN) stimulation can suppress undesired detrusor bladder contractions in patients with both neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD). Detrusor pressure (Pdet) and EUS EMG were recorded in 12 neurogenic patients who underwent two filling cystometries. The first one was

E. Opisso; A. Borau; N. J. M. Rijkhoff

2011-01-01

185

Prospective study of the extent of internal anal sphincter division during lateral sphincterotomy  

Microsoft Academic Search

PURPOSE: The aim of lateral internal anal sphincterotomy when treating anal fissure is to divide the distal one-third to one-half of the internal anal sphincter. This study aimed to evaluate prospectively the extent of disruption to the internal anal sphincter following lateral anal internal sphincterotomy and also to establish the prevalence of symptoms of anal incontinence in these patients. METHODS:

Abdul H. Sultan; Michael A. Kamm; R. John Nicholls; Clive I. Bartram

1994-01-01

186

Influence of pudendal block on the function of the anal sphincters  

Microsoft Academic Search

The function of the anal sphincters has been studied by obtaining continuous recordings of the pressure in the anal canal and the electromyographic activity in the striated sphincter muscles during expansion of the ampulla recti by means of an air balloon. Ten healthy subjects were examined before and after the striated muscles had been entirely paralysed by bilateral pudendal block,

B Frenckner; C V Euler

1975-01-01

187

Effects of Gabexate Mesilate, a Protease Inhibitor, on Human Sphincter of Oddi Motility  

Microsoft Academic Search

Gabexate mesilate is an antiprotease drug, which reduced the severity of pancreatitis and frequency of post-ERCP pancreatitis. In dogs gabexate inhibits sphincter of Oddi motility but no data are available in humans. The aim of this study was to verify by manometry the action of gabexate on human sphincter of Oddi motility. We enrolled 12 patients with idiopathic recurrent pancreatitis

Vincenzo Di Francesco; Alberto Mariani; Giampaolo Angelini; Enzo Masci; Luca Frulloni; Giorgio Talamini; Sandro Passaretti; Pieralberto Testoni; Giorgio Cavallini

2002-01-01

188

Are sphincter defects the cause of anal incontinence after vaginal delivery?  

Microsoft Academic Search

PURPOSE: Anal incontinence affects approximately 10 percent of adult females. Damage to the anal sphincters has been considered as the cause of anal incontinence after childbirth in the sole prospective study so far available. The aims of the present study were to determine prospectively the incidence of anal incontinence and anal sphincter damage after childbirth and their relationship with obstetric

Laurent Abramowitz; Iradj Sobhani; Roland Ganansia; Albert Vuagnat; Jean Louis Benifla; Emile Darai; Patrick Madelenat; Michel Mignon

2000-01-01

189

Anal sphincter repair for obstetric injury: Manometric evaluation of functional results  

Microsoft Academic Search

Anal manometry before and after surgical repair on a homogeneous group of patients with anterior sphincter defect caused by obstetric injury defined the parameters affected by the repair to achieve anal continence. Between November 1985 and April 1989, 28 patients who underwent anterior anal sphincter reconstruction were studied using anal manometry and were graded for continence. Anal function was improved

James W. Fleshman; Zeev Dreznik; Robert D. Fry; Ira J. Kodner

1991-01-01

190

Postoperative anal canal length predicts outcome in patients having sphincter repair for fecal incontinence  

Microsoft Academic Search

PURPOSE: Controversy exists in regard to the prognostic value of clinical data and physiological tests in patients undergoing sphincter repair for fecal incontinence. The aim of this study was to identify prognostic factors. METHODS: Between 1986 and 1996, 405 consecutive patients had a sphincter repair for fecal incontinence. Preoperative and postoperative manometric data were available on 51 of these patients,

Graham R. Hool; Michael L. Lieber; James M. Church

1999-01-01

191

Paradoxical response to cerulein on sphincter of Oddi in the patient with gastrectomy  

Microsoft Academic Search

Sphincter of Oddi motility was measured in 55 gallstone patients either through the sinus tract of percutaneous transhepatic biliary drainage or through the T tube. The influence of cholecystectomy and gastrectomy on the sphincter of Oddi was analyzed by comparing responses in patients with or without surgery to the administration of cerulein and the ingestion of dry egg yolk. When

Katsuyoshi Odani; Yuji Nimura; Akihiro Yasui; Yukihiko Akita; Shigehiko Shionoya

1992-01-01

192

Can endoscopic papillary balloon dilation really preserve sphincter of Oddi function?  

Microsoft Academic Search

BACKGROUNDEndoscopic papillary balloon dilation (EPBD) is assumed to preserve sphincter of Oddi function because it causes little trauma to the papilla. However, few studies have addressed this issue specifically. In this study, we investigated whether EPBD can preserve sphincter function, and evaluated whether or not such preservation has clinical significance.METHODSSeventy patients with common bile duct (CBD) stones were randomly assigned

I Yasuda; E Tomita; M Enya; T Kato; H Moriwaki

2001-01-01

193

Manometric study of the sphincter of Oddi in patients with and without common bile duct stones  

Microsoft Academic Search

Motor activity of the sphincter of Oddi has been evaluated in 34 patients who underwent ERCP examination. Manometric recordings from the common bile duct and the sphincter of Oddi were performed with a polyethylene triple lumen catheter. At ERCP 16 patients had undamaged biliary ducts; six had undergone cholecystectomy and six had gall bladder stones; 18 patients had common bile

E De Masi; E Corazziari; F I Habib; B Fontana; V Gatti; G F Fegiz; A Torsoli

1984-01-01

194

Action of Cholecystokinin and Caerulein on the Rabbit Sphincter of Oddi  

Microsoft Academic Search

The action of cholecystokinin (CCK) and caerulein upon the rabbit sphincter of Oddi was investigated by eiectromyography, manometry and measuring of the flow. Intravenous injection of CCK resulted in a marked rise of the sphincter activity with a maximum at the 1st min and return to the basal level at the 10th min. Injection of increasing doses of hormone showed

J. C. Sarles; J. M. Bidart; M. A. Devaux; C. Echinard; A. Castagnini

1976-01-01

195

ERCP, biliary crystal analysis, and sphincter of Oddi manometry in idiopathic recurrent pancreatitis  

Microsoft Academic Search

Background: This study investigated the role of ERCP, analysis of bile for microcrystals, and sphincter of Oddi manometry in idiopathic recurrent pancreatitis. Methods: One hundred twenty-six patients met criteria for idiopathic recurrent pancreatitis. Patients with a normal ERCP underwent sphincter of Oddi manometry and analysis of bile. Bile was also collected in patients with papillary stenosis (defined as ductal dilation

Madhukar Kaw; George J. Brodmerkel

2002-01-01

196

Anal sphincter biofeedback relaxation treatment for women with intractable constipation symptoms  

Microsoft Academic Search

Some constipated women have difficulty relaxing the striated muscles of the anal sphincters, sometimes called anismus. This study was developed to provide a biofeedback-based relaxation treatment to teach these patients to relax the “voluntary” anal sphincter muscle in order to assess whether this treatment would be effective in reducing symptomatology. Seven constipated patients who were unresponsive to a high-fiber diet

Geoffrey K. Turnbull; Paul G. Ritvo

1992-01-01

197

Development and Current Status of the AMS 800 Artificial Urinary Sphincter  

Microsoft Academic Search

The American Medical Systems (AMS) 800 artificial urinary sphincter (AUS) has developed into a sophisticated system for the treatment of patients with incontinence secondary to intrinsic sphincter deficiency. In this review article, we describe the development and mechanics of the device before considering the indications for its use. We present a comprehensive review of the recent literature concerning long term

Hari L. Ratan; Duncan J. Summerton; Steven K. Wilson; Timothy R. Terry

2006-01-01

198

Contact neodymium:yttrium-aluminum-garnet laser ablation of the external sphincter in spinal cord injured men with detrusor sphincter dyssynergia  

Microsoft Academic Search

ObjectivesThe purpose of this study was to determine the efficacy and safety of contact neodymium:yttrium-aluminum-garnet (Nd:YAG) laser external sphincterotomy as an alternative treatment of detrusor-external sphincter dyssynergia (DESD).

David A. Rivas; Michael B. Chancellor; William E. Staas; Leonard G. Gomella

1995-01-01

199

Translabial ultrasound assessment of the anal sphincter complex: normal measurements of the internal and external anal sphincters at the proximal, mid-, and distal levels  

Microsoft Academic Search

The purpose of this study was to measure the internal and external anal sphincters using translabial ultrasound (TLU) at the\\u000a proximal, mid, and distal levels of the anal sphincter complex. The human review committee approval was obtained and all women\\u000a gave written informed consent. Sixty women presenting for gynecologic ultrasound for symptoms other than pelvic organ prolapse\\u000a or urinary or

Rebecca J. Hall; Rebecca G. Rogers; Lori Saiz; C. Qualls

2007-01-01

200

The relation of sensation in the anal canal to the functional anal sphincter: a possible factor in anal continence  

Microsoft Academic Search

In normal subjects the length of the functional anal sphincter has been compared with the extent of sensation to light touch in the anal canal. At rest, the sphincteric zone was the longer. On distension of the rectum, a decrease in pressure in the anal canal so shortened the functional sphincter that intrarectal pressure extended down to contact the sensory

H. L. Duthie; R. C. Bennett

1963-01-01

201

The rebound excitation triggered by anticholinergic drugs from ovine pyloric antrum, small bowel and gallbladder.  

PubMed

The effect of anticholinergic drugs on gastrointestinal motility is complex and incompletely recognized. Accordingly, in 6 adult sheep bipolar electrodes and strain gage force transducers were surgically attached to the antral, small intestinal and gallbladder wall at the serosal side. During chronic experiments the myoelectric and mechanical recordings were performed in fasted and non-fasted animals before and after various doses of hexamethonium, atropine and pirenzepine given intravenously. Hexamethonium administration triggered rebound excitation after an inhibitory period almost in all the recording sites. Administration of atropine and pirenzepine evoked these secondary contractions mostly in the small intestine and gallbladder. No rebounds were observed when the anticholinergic drugs were given during feeding. In fasted animals, rebound excitation arrived later but more frequently than in non-fasted animals. The excitatory changes were dose-dependent. In the gallbladder, these values were lower than in the small intestine. The frequency of the recurrent pattern was dependent upon the dose of the anticholinergic drug used. It is concluded that nicotinic receptors are more important than muscarinic receptors in the initiation of the rebound excitation in pyloric antrum while in the small bowel and gallbladder the role of both cholinergic receptors is similar. The anticholinergic drugs should be used with caution in all these clinical situations, where the enhancement of gastrointestinal motility must be avoided. PMID:12674224

Roma?ski, K W

2003-03-01

202

Genome-wide linkage analysis in families with infantile hypertrophic pyloric stenosis indicates novel susceptibility loci.  

PubMed

Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of upper gastrointestinal obstruction during infancy. A multifactorial background of the disease is well established. Multiple susceptibility loci including the neuronal nitric oxide synthase (NOS1) gene have previously been linked to IHPS, but contradictory results of linkage studies in different materials indicate genetic heterogeneity. To identify IHPS susceptibility loci, we conducted a genome-wide linkage analysis in 37 Swedish families. In regions where the Swedish material showed most evidence in favor of linkage, 31 additional British IHPS families were analyzed. Evidence in favor of significant linkage was observed in the Swedish material to two loci on chromosome 2q24 (non-parametric linkage (NPL) =3.77) and 7p21 (NPL=4.55). In addition, evidence of suggestive linkage was found to two loci on chromosome 6p21 (NPL=2.97) and 12q24 (NPL=2.63). Extending the material with British samples did not enhance the level of significance. Regions with linkage harbor interesting candidate genes, such as glucagon-like peptide-2 (GLP-2 encoded by the glucagon gene GCG), NOS1, motilin (MLN) and neuropeptide Y (NPY). The coding exons for GLP-2, and NPY were screened for mutations with negative results. In conclusion, we could confirm suggestive linkage to the region harboring the NOS1 gene and detected additional novel susceptibility loci for IHPS. PMID:22158425

Svenningsson, Anna; Söderhäll, Cilla; Persson, Sofia; Lundberg, Fredrik; Luthman, Holger; Chung, Eddie; Gardiner, Mark; Kockum, Ingrid; Nordenskjöld, Agneta

2012-02-01

203

A homozygous mutation in the integrin alpha6 gene in junctional epidermolysis bullosa with pyloric atresia.  

PubMed Central

The alpha6 integrin subunit participates in the formation of both alpha6beta1 and alpha6beta4 laminin receptors, which have been reported to play an important role in cell adhesion and migration and in morphogenesis. In squamous epithelia, the alpha6beta4 heterodimer is the crucial component for the assembly and stability of hemidesmosomes. These anchoring structures are ultrastructurally abnormal in patients affected with junctional epidermolysis bullosa with pyloric atresia (PA-JEB), a recessively inherited blistering disease of skin and mucosae characterized by an altered immunoreactivity with antibodies specific to integrin alpha6beta4. In this report, we describe the first mutation in the alpha6 integrin gene in a PA-JEB patient presenting with generalized skin blistering, aplasia cutis, and defective expression of integrin alpha6beta4. The mutation (791delC) is a homozygous deletion of a single base (C) leading to a frameshift and a premature termination codon that results in a complete absence of alpha6 polypeptide. We also describe the DNA-based prenatal exclusion of the disease in this family at risk for recurrence of PA-JEB. Our results demonstrate that, despite the widespread distribution of the alpha6 integrin subunit, lack of expression of the alpha6 integrin chain is compatible with fetal development, and results in a phenotype indistinguishable from that caused by mutations in the beta4 chain, which is expressed in a more limited number of tissues.

Ruzzi, L; Gagnoux-Palacios, L; Pinola, M; Belli, S; Meneguzzi, G; D'Alessio, M; Zambruno, G

1997-01-01

204

Successful Implantation of Bioengineered, Intrinsically Innervated, Human Internal Anal Sphincter  

PubMed Central

Background & Aims To restore fecal continence, the weakened pressure of the internal anal sphincter (IAS) must be increased. We bioengineered intrinsically innervated human IAS, to emulate sphincteric physiology, in vitro. Methods We co-cultured human IAS circular smooth muscle with immortomouse fetal enteric neurons. We investigated the ability of bioengineered innervated human IAS, implanted in RAG1?/? mice, to undergo neovascularization and preserve the physiology of the constituent myogenic and neuronal components. Results The implanted IAS was neovascularized in vivo; numerous blood vessels were observed with no signs of inflammation or infection. Real-time force acquisition from implanted and pre-implant IAS showed distinct characteristics of IAS physiology. Features included the development of spontaneous myogenic basal tone; relaxation of 100% of basal tone in response to inhibitory neurotransmitter vasoactive intestinal peptide (VIP) and direct electrical field stimulation of the intrinsic innervation; inhibition of nitrergic and VIPergic EFS-induced relaxation (by antagonizing nitric oxide synthesis or receptor interaction); contraction in response to cholinergic stimulation with acetylcholine; and intact electromechanical coupling (evidenced by direct response to potassium chloride). Implanted, intrinsically innervated bioengineered human IAS tissue preserved the integrity and physiology of myogenic and neuronal components. Conclusion Intrinsically innervated human IAS bioengineered tissue can be successfully implanted in mice. This approach might be used to treat patients with fecal incontinence.

Raghavan, Shreya; Gilmont, Robert R.; Miyasaka, Eiichi A.; Somara, Sita; Srinivasan, Shanthi; Teitelbaum, Daniel H; Bitar, Khalil N.

2011-01-01

205

Choledochoscope manometry about different drugs on the Sphincter of Oddi  

PubMed Central

AIM: To assess the effects of H2-receptor blocking pharmacon, protease inhibitor, and gastro kinetic agents on the human Sphincter of Oddi (SO) motility by choledochoscope manometry. METHODS: One hundred and seventy-five patients with T tube installed after cholecystectomy and choledochotomy were assessed by choledochoscope manometry. They were randomly assigned into groups of H2-receptor blocking pharmacon, protease inhibitor, and gastro kinetic agents. The Sphincter of Oddi basal pressure (SOBP), amplitude (SOCA), frequency of contractions (SOF), duodenal pressure (DP), and common bile duct pressure (CBDP) were scored and analyzed. RESULTS: SOBP and SOCA were significantly decreased after Cimetidine administration, and no statistical difference was seen in the Famotidine group. In the Gabexate mesilate group, SOBP had decreased significantly. In the Ulinastatin group, SOCA decreased when Ulinastatin was given at the rate of 2500 U/min; when Ulinastatin administration was raised to 5000 U/min, SOBP, SOF and SOCA all experienced a fall. SOBP and SOCA for Domperidone and SOCA for Mosapride groups all decreased distinctly after administration. CONCLUSION: The regular dosage of Cimetidine showed an inhibitory effect on the motility of SO, while Famotidine had no obvious effects otherwise. Gabnexata mesilate, Ulinastatin and gastro kinetic agents also showed inhibitory effects on the SO motility.

Kong, Jing; Wu, Shuo-Dong; Zhang, Xiao-Bo; Li, Zhen-Sheng; Shi, Gang; Wang, Wei; Chen, Jun-Zhi

2008-01-01

206

Anal sphincter injuries during hemorrhoidectomy: a multi center study.  

PubMed

Hemorrhoidectomy is the treatment of choice for patients with third or fourth-degree hemorrhoids. Although the majority of surgeons believe that surgical hemorrhoidectomy is the most effective approach with excellent results in the management of hemorrhoid disease, but hemorrhoidectomy is not a simple procedure. One of the complications of this surgery is an injury to anal sphincters that can lead to incontinency in some patients. In this study, we aimed to reveal the percentage of external and internal anal sphincter injuries in surgical hemorrhoidectomy. We prospectively enrolled 128 patients from April 2006 to February 2007. They underwent hemorrhoidectomy in three general hospitals in Tehran. All patients were in grade III or IV and underwent open hemorrhoidectomy (Milligan-Morgan). After surgery, all resected material was histopathologically examined by two expert pathologists and the results confirmed by other one if there is any discrepancy. From all specimens which sent to the pathology department 15.8% (21 Pts.) had muscle fibers that Smooth muscle fibers were seen in 80.5% (17 Pts.) of them and striated muscle fibers were found in 19.5% (4 Pts.). Although hemorrhoidectomy is a safe and effective method for treatment of hemorrhoid, but the inadvertent removal of smooth and striated muscle during open hemorrhoidectomy had raised concerns about its effects on postoperative anorectal function. PMID:23165814

Mirzaei, Rezvan; Mahjoubi, Bahar; Kadivar, Maryam; Azizi, Rasoul; Zahedi-Shoolami, Leila

2012-01-01

207

CAN BE SPHINCTER ELECTROMYOGRAPHY REFERENCE VALUES SHARED BETWEEN LABORATORIES?1  

PubMed Central

Aims: Sphincter electromyography (EMG) is an important method in diagnosis of neuropathic sacral lesions. Quantitative EMG analysis increases utility of the test, but requires valid reference values. Although commonly employed, validity of sharing reference data between electrodiagnostic laboratories has not been confirmed. In this study, this approach was assessed by comparing the reproducibility of data sets obtained by the same and different laboratories. Methods: Confidence intervals and sensitivity of motor unit potential (MUP) parameters in the external anal sphincter (EAS) muscles were calculated using data obtained from 3 different control groups of women (number of women: 41, 48 and 66), examined by the same (the first two groups) and another investigator (the third group). Sensitivities to diagnose neuropathic changes in a known patient group were compared. Results: When compared to the first reference group, the MUP parameter means of 2/7 (same investigator) vs. 3/7 (different investigator) were significantly different. Similarly, 3/14 vs. 4/14 MUP parameter outliers were different. Finally, 6/14 vs. 7/14 sensitivities (using a combination of MUP parameter means and outliers) were different. Conclusions: This study demonstrated somewhat larger differences between confidence intervals obtained by different investigators, as compared to those obtained by a single investigator. However, most of these differences can be explained by differences in recruited groups of women, and slight inconsistencies in applied techniques. Presented data suggest that confidence intervals from other laboratories can be used, but only if exact protocols from original normative studies are strictly followed.

Podnar, Simon; Gregory, W. Thomas

2010-01-01

208

Is There Any Correlation Between Objective Anal Testing, Rupture Grade, and Bowel Symptoms After Primary Repair of Obstetric Anal Sphincter Rupture?  

Microsoft Academic Search

PURPOSE: The purpose of this study was to investigate the relationships between the grade of anal sphincter rupture, anal sphincter defect, manometry variables, and anal incontinence. METHODS: A total of 132 females with first-time obstetric sphincter rupture were evaluated by transanal ultrasound, manometry, and scoring of bowel symptoms five months after delivery. RESULTS: Anal sphincter rupture and transanal ultrasound grade

Mohammad Nazir; Erik Carlsen; Anne Flem Jacobsen; Britt-Ingjerd Nesheim

2002-01-01

209

Gastric and pyloric motor pattern control by a modulatory projection neuron in the intact crab Cancer pagurus.  

PubMed

Neuronal release of modulatory substances provides motor pattern generating circuits with a high degree of flexibility. In vitro studies have characterized the actions of modulatory projection neurons in great detail in the stomatogastric nervous system, a model system for neuromodulatory influences on central pattern generators. Less is known about the activities and actions of modulatory neurons in fully functional and richly modulated network settings, i.e., in intact animals. It is also unknown whether their activities contribute to the motor patterns in different behavioral conditions. Here, we show for the first time the activity and effects of the well-characterized modulatory projection neuron 1 (MCN1) in vivo and compare them to in vitro conditions. MCN1 was always spontaneously active, typically in a rhythmic fashion with its firing being interrupted by ascending inhibitions from the pyloric motor circuit. Its activity contributed to pyloric motor activity, because 1) the cycle period of the motor pattern correlated with MCN1 firing frequency and 2) stimulating MCN1 shortened the cycle period while 3) lesioning of the MCN1 axon reduced motor activity. In addition, gastric mill motor activity was elicited for the duration of the stimulation. Chemosensory stimulation of the antennae moved MCN1 away from baseline activity by increasing its firing frequency. Following this increase, a gastric mill rhythm was elicited and the pyloric cycle period decreased. Lesioning the MCN1 axon prevented these effects. Thus modulatory projection neurons such as MCN1 can control the motor output in vivo, and they participate in the processing of exteroceptive sensory information in behaviorally relevant conditions. PMID:21325688

Hedrich, Ulrike B S; Diehl, Florian; Stein, Wolfgang

2011-04-01

210

Effect of propofol on anal sphincter pressure during anorectal manometry.  

PubMed

We evaluated the effect of propofol on resting anal sphincter pressure (RP) during anorectal manometry performed under general anesthesia in 20 children with chronic constipation. After propofol bolus administration, there was a significant decrease in the RP in 95% of children from a mean of 51.5 ± 15.3 to a mean nadir of 21.7 ± 10.5 mmHg (P < 0.001). The new postpropofol RP of 47.0 ± 12.4 mmHg was significantly lower compared with prepropofol RP (P < 0.0001). Propofol should be used with caution as an anesthetic agent for anorectal manometry, given the potential for confounding RP measurements. PMID:24121151

Tran, Khoa; Kuo, Brad; Zibaitis, Audrius; Bhattacharya, Somaletha; Cote, Charles; Belkind-Gerson, Jaime

2014-04-01

211

Gracilis muscle as neoanal sphincter for faecal incontinence.  

PubMed

Faecal incontinence is a debilitating chronic clinical condition which may affect the patient and care givers. Modality of treatment is based on severity of the symptoms as well as the anatomical defect itself, availability of resources and expertise. We describe a modified technique of dynamic graciloplasty as neoanal sphincter for the treatment severe faecal incontinence who has failed previous over lapping sphincteroplasty. In our modified version, instead of using implanted intramuscular electrodes and subcutaneous neurostimulator to provide continuous stimulation, the patient will undergo an external stimulation on the nerve of transplanted gracilis periodically and concurrent biofeedback therapy. We believe the technique is relatively easy to learn and very cost effective without any electrodes or neurostimulator related complications. PMID:21265253

Zailani, M H M; Azmi, M N; Deen, K I

2010-03-01

212

[Reconstruction of velopharyngeal sphincter in secondary Cleft Palate: surgical alternative].  

PubMed

There are numerous surgical procedures for the repair of Cleft Palate (CP). Since 1998, in children with CP we use a modified Wardill-Kilner technique, with a large section of the nasal mucous layer at the level of the muscular insertion on the hard palate and lateral nasopharingeal wall, obtaining a push-back and reorientation of the muscular fibres without dissection, diminishing this way the risks of haemorrhages and fibrosis, simplifying the intervention. It allows a lower operative time and a short internment. The aim of our study was to evaluate the results of this operative procedure specially in the development of the speech in 73 children operated on from 1998 until 2000 in our hospital. We verify a competence of the velopharingeal sphincter with ideal results in speech in 88,8% of the cases. PMID:16846134

Recamán, M; Bonet, B; Leitão, J; Mesquita, A

2006-04-01

213

Urethral sphincter EMG as event detector for Neurogenic detrusor overactivity.  

PubMed

The aim of this study was to investigate the feasibility of using external urethral sphincter electromyogram (EMG) (EUSEMG) to detect the onset of detrusor contractions in patients with both neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD). Detrusor pressure (Pdet) and EUSEMG was recorded in 23 neurogenic patients during slow artificial bladder filling. The time delay between the onset of a detrusor contraction and the onset of EUSEMG activity was calculated together with the detrusor pressure increase related to this delay. Of 23 patients enrolled, 12 patients showed both NDO and DSD. Of these 12 patients, 10 had a strong correlation between detrusor pressure and EUSEMG. One patient in this group was excluded due to a storage pressure above 30 cm H2O. Two detection methods were applied on the remaining 9 patients. Method 1 was a root mean square (RMS)-integrator with simple thresholding. This approach had a good sensitivity but also a poor specificity (many false-positive detections). Detection method 2 included a kurtosis-based scaling function, which was multiplied to a similar RMS-integrator as used in method 1. Onset detection occurred before Pdet exceeded 18 cm H2O with both methods. However, method 1 resulted in 14.1 +/- 12.8 false-positive detections during one bladder filling. Pdet at onset detection was on average 1.0 +/- 1.1 cmH2 0 higher with detection method 2 but the number of false-positives was reduced by 95.8%. This paper demonstrates the feasibility of using EUSEMG to estimate the onset of a detrusor contraction in selected patients. PMID:17605352

Hansen, John; Borau, Albert; Rodríguez, Alfred; Vidal, Joan; Sinkjaer, Thomas; Rijkhoff, Nico J M

2007-07-01

214

Dysfunctional voiding: A review of the terminology, presentation, evaluation and management in children and adults  

PubMed Central

Dysfunctional voiding (DV) is a voiding disorder characterized by dyssynergic striated sphincteric activity in the absence of a proven neurological etiology. It can present at any age with a spectrum of storage and voiding symptoms that may resemble florid neurogenic bladder. There is a striking lack of clarity regarding what this entity represents, the diagnostic methodology and treatment. The limitations of existing guideline documents are analyzed. Specifically, use of the term “habitual”, the assumption that bladder changes are secondary to the outlet, the emphasis on “staccato” voiding and the implication of striated urethral sphincter are discussed. Literature shows that DV may also present with continuous slow flow or normal flow. Dyssynergia may be at the level of the striated urethral sphincter, the pelvic floor or both, better termed “striated urethral sphincter-pelvic floor complex” (SUS-PFC).A diagnostic algorithm is provided so that patients are evaluated on merit rather than on the basis of different philosophies of individual centers. High-risk markers such as hydronephrosis, vesicoureteral reflux, renal failure or marked voiding difficulty should prompt a formal urodynamics evaluation and imaging for neurological etiology. Patients with predominantly storage symptoms with incidental staccato voiding can be managed initially, on the basis of non-invasive evaluation. Conservative urotherapy including biofeedback is appropriate initial management for patients without high risk factors. Treatment and evaluation should be escalated based on response. Patients with severe DV will need treatment similar to neurogenic bladder including clean intermittent catheterization and measures to control storage pressures.

Sinha, Sanjay

2011-01-01

215

Preventing kidney injury in children with neurogenic bladder dysfunction.  

PubMed

The most common cause of neurogenic bladder dysfunction (NBD) in newborn infants is myelomeningocele. The pathophysiology almost always involves the bladder detrusor sphincter dyssynergy (DSD), which if untreated can cause severe and irreversible damage to the upper and lower urinary tracts. Early diagnosis and adequate management of NBD is critical to prevent both renal damage and bladder dysfunction and to reduce chances for the future surgeries. Initial investigation of the affected newborn infant includes a renal and bladder ultrasound, measurement of urine residual, determination of serum creatinine level, and urodynamics study. Voiding cystogram is indicated when either hydronephrosis or DSD is present. The main goal of treatment is prevention of urinary tract deterioration and achievement of continuance at an appropriate age. Clean intermittent catheterization (CIC) in combination with anticholinergic (oxybutynin) and antibiotics are instituted in those with high filling and voiding pressures, DSD and/or high grade reflux immediately after the myelomeningocele is repaired. Botulium toxin-A injection into detrusor is a safe alternative in patients with insufficient response or significant side effects to anticholinergic (oral or intravesical instillation) therapy. Surgery is an effective alternative in patients with persistent detrusor hyperactivity and/or dyssynergic detrusor sphincter despites of the CIC and maximum dosage of anticholinergic therapy. Children with NBD require care from a multidisciplinary team approach consisting of pediatricians, neurosurgeon, urologist, nephrologists, orthopedic surgeon, and other allied medical specialists. PMID:24498490

Larijani, Faezeh Javadi; Moghtaderi, Mastaneh; Hajizadeh, Nilofar; Assadi, Farahnak

2013-12-01

216

Dynamic Rectus Abdominis Muscle Sphincter for Stomal Continence  

Microsoft Academic Search

Some life-saving surgeries result in the necessity to establish permanent intestinal stomas; this outcome has an undeniable physical and emotional effect on the patient's life. Although patients with permanent stomas reasonably adjust, complications that include peristomal skin irritation, pouching system dysfunction, social inhibition, depression, and sexual dysfunction also have been reported. \\u000aThe quest for intestinal stomal continence has resulted in

J. W. J. M. Bardoel

2002-01-01

217

TRANSURETHRAL COLLAGEN INJECTIONS FOR MALE INTRINSIC SPHINCTER DEFICIENCY: THE UNIVERSITY OF TEXAS-HOUSTON EXPERIENCE  

Microsoft Academic Search

PurposeInjectable agents are used to increase urethral coaptation for the treatment of intrinsic sphincter deficiency. We evaluated the long-term results and complications of transurethral collagen injections in males.

O. LENAINE WESTNEY; RICHARD BEVAN-THOMAS; J. LYNN PALMER; R. DUANE CESPEDES; EDWARD J. McGUIRE

2005-01-01

218

[The role of esophageal sphincter tonus and of gastric motility in the extent of reflux esophagitis].  

PubMed

Thirty-two patients with symptomatic gastroesophageal reflux disease were investigated by esophagogastroduodenoscopy, 24 h pH monitoring, esophageal manometry and measurement of gastric emptying of solids, in order to elucidate the relative importance of lower esophageal sphincter tone, amount of acid reflux and gastric emptying on the degree of esophagitis. The mechanical competency of lower esophageal sphincter was significantly deranged in patients with moderate/severe esophagitis than in patients with mild esophagitis. The gastric emptying time was significantly delayed in patients with moderate/severe esophagitis than in patients with mild esophagitis. No relationship was observed between amount of acid reflux, lower esophageal sphincter function and gastric emptying time. Our results suggest that resting pressure of lower esophageal sphincter and the gastric motor function play a major role in severity of reflux esophagitis. PMID:1553047

Cogliandolo, A; Gulino, F M; Pustorino, S; Migliorato, D; Bottari, M; Saitta, F P; Micali, B

1992-01-01

219

Relationship Between Surgeon Caseload and Sphincter Preservation in Patients With Rectal Cancer  

Microsoft Academic Search

PURPOSE  The aim of this study was to determine by means of a national database whether higher surgeon caseload correlates with greater utilization of sphincter-sparing procedures than of abdominoperineal resections in treatment of patients with rectal cancer.METHODS  Patients with a primary International Classification of Diseases-9 diagnosis code of rectal cancer who underwent a sphincter-sparing procedure or abdominoperineal resection were selected from the

Harriett Purves; Ricardo Pietrobon; Sheleika Hervey; Ulrich Guller; William Miller; Kirk Ludwig

2005-01-01

220

Purification and biochemical characterization of an acid-stable lipase from the pyloric caeca of sardine (Sardinella aurita).  

PubMed

A lipolytic activity was located in the sardine digestive glands (pyloric caeca), from which a sardine digestive lipase (SaDL) was purified. Pure SaDL has a molecular mass of 43 kDa as determined by sodium dodecyl sulfate polyacrylamide gel electrophoresis analysis. The enzyme was found to be more active on short-chain triacylglycerols than on long-chain ones. SaDL does not present the interfacial activation phenomenon. Control experiments were performed under the same experimental conditions, with dromedary and turkey pancreatic lipases and showed a positive interfacial activation phenomenon. Sodium deoxycholate (NaDC) has an inhibitory effect on the lipase activity. The pure enzyme lost 40% of its activity in presence of 8 mM NaDC. SaDL was found to be mostly stable at low pH values. Interestingly, no colipase was detected in the sardine pyloric caeca. Analogous results were reported for the scorpion and the crab digestive systems. This is in line with the idea that colipase might has evolved in mammal animals simultaneously with the appearance of an exocrine pancreas. No similarity was found between the NH(2)-terminal amino acid residues of SaDL and those of lipases from the digestive tract of other species. Altogether, these results suggest that SaDL is a member of a new group of lipases belonging to aquatic species. PMID:20383604

Smichi, Nabil; Fendri, Ahmed; Chaâbouni, Raja; Ben Rebah, Faouzi; Gargouri, Youssef; Miled, Nabil

2010-11-01

221

Non-linear membrane properties of sacral sphincter motoneurones in the decerebrate cat  

PubMed Central

Responses to pudendal afferent stimulation and depolarizing intracellular current injection were examined in sacral sphincter motoneurones in decerebrate cats. In 16 animals examined, 2–10 s trains of electrical stimulation of pudendal afferents evoked sustained sphincter motoneurone activity lasting from 5 to >50 s after stimulation. The sustained response was observed in: 11 animals in the absence of any drugs; two animals after the intravenous administration of 5-hydroxytryptophan (5-HTP; ? 20 mg kg?1); one animal in which methoxamine was perfused onto the ventral surface of the exposed spinal cord; and two animals following the administration of intravenous noradrenergic agonists. Extracellular and intracellular recordings from sphincter motoneurones revealed that the persistent firing evoked by afferent stimulation could be terminated by motoneurone membrane hyperpolarization during micturition or by intracellular current injection. Intracellular recordings revealed that 22/40 sphincter motoneurones examined displayed a non-linear, steep increase in the membrane potential in response to depolarizing ramp current injection. The mean voltage threshold for this non-linear membrane response was -43 ± 3 mV. Five of the 22 cells displaying the non-linear membrane response were recorded prior to the administration of 5-HTP; 17 after the intravenous administration of 5-HTP (? 20 mg kg?1). It is concluded that sphincter motoneurones have a voltage-sensitive, non-linear membrane response to depolarization that could contribute to sustained sphincter motoneurone firing during continence.

Paroschy, K L; Shefchyk, S J

2000-01-01

222

Maternal Body Mass Index and Risk of Obstetric Anal Sphincter Injury  

PubMed Central

Objective. To estimate the association between maternal obesity and risk of three different degrees of severity of obstetric anal sphincter injury. Methods. The study population consisted of 436,482 primiparous women with singleton term vaginal cephalic births between 1998 and 2011 identified in the Swedish Medical Birth Registry. Women were grouped into six categories of BMI. BMI 18.5–24.9 was set as reference. Primary outcome was third-degree perineal laceration, partial or total, and fourth-degree perineal laceration. Adjustments were made for year of delivery, maternal age, fetal head position at delivery, infant birth weight and instrumental delivery. Results. The overall prevalence of third- or four-degree anal sphincter injury was 6.6% (partial anal sphincter injury 4.6%, total anal sphincter injury 1.2%, unclassified as either partial and total 0.2%, or fourth degree lacerations 0.6%). The risk for a partial, total, or a fourth-degree anal sphincter injury decreased with increasing maternal BMI most pronounced for total anal sphincter injury where the risk among morbidly obese women was half that of normal weight women, OR 0.47 95% CI 0.28–0.78. Conclusion. Obese women had a favourable outcome compared to normal weight women concerning serious pelvic floor damages at birth.

2014-01-01

223

Quantification of Intramuscular Nerves Within the Female Striated Urogenital Sphincter Muscle  

PubMed Central

Objective To analyze the quantity and distribution of intramuscular nerves within the striated urogenital sphincter and test the hypothesis that decreased nerve density is associated with decreased striated sphincter muscle and cadaver age. Methods Thirteen cadaveric urethras (mean age 47 years, range 15–78 years) were selected for study. A sagittal histologic section was stained with S100 stain to identify intramuscular nerves. The number of times that a nerve was seen within the striated urogenital sphincter (nerve number) was counted. The number of axons within each nerve fascicle was also counted. Regression analysis of nerve density against muscle cell number and age was performed. Results Remarkable variation was found in the quantity of intramuscular nerves in the striated urogenital sphincter of the 13 urethras studied. The number of nerves ranged from 72 to 543, a sevenfold variation (mean 247.1 ± standard deviation 123.2), and the range of number of axons was 431 to 3523 (2201 ± 1152.6). The larger nerve fascicles were seen predominantly in the distal (13.1 ± 5.7 axons per nerve) compared with the proximal part of the striated urogenital sphincter (1.2 ± 2). Reduced nerve density throughout the striated urogenital sphincter correlated with fewer muscle cells (P = .02). Nerve density also decreased with advancing age (P = .004). Conclusion Remarkable variation in the quantity of intramuscular nerves was found. Women with sparse intramuscular nerves had fewer striated muscle cells. Intramuscular nerve density declined with age.

PANDIT, MEGHANA; DELANCEY, JOHN O. L.; ASHTON-MILLER, JAMES A.; IYENGAR, JYOTHSNA; BLAIVAS, MILA; PERUCCHINI, DANIELE

2005-01-01

224

Sphincter saving anorectoplasty (SSARP) for the reconstruction of Anorectal malformations  

PubMed Central

Background This report describes a new technique of sphincter saving anorectoplasty (SSARP) for the repair of anorectal malformations (ARM). Methods Twenty six males with high ARM were treated with SSARP. Preoperative localization of the center of the muscle complex is facilitated using real time sonography and computed tomography. A soft guide wire is inserted under image control which serves as the route for final pull through of bowel. The operative technique consists of a subcoccygeal approach to dissect the blind rectal pouch. The separation of the rectum from the fistulous communication followed by pull through of the bowel is performed through the same incision. The skin or the levators in the midline posteriorly are not divided. Postoperative anorectal function as assessed by clinical Wingspread scoring was judged as excellent, good, fair and poor. Older patients were examined for sensations of touch, pain, heat and cold in the circumanal skin and the perineum. Electromyography (EMG) was done to assess preoperative and postoperative integrity of external anal sphincter (EAS). Results The patients were separated in 2 groups. The first group, Group I (n = 10), were newborns in whom SSARP was performed as a primary procedure. The second group, Group II (n = 16), were children who underwent an initial colostomy followed by delayed SSARP. There were no operative complications. The follow up ranged from 4 months to 18 months. Group I patients have symmetric anal contraction to stimulation and strong squeeze on digital rectal examination with an average number of bowel movements per day was 3–5. In group II the rate of excellent and good scores was 81% (13/16). All patients have an appropriate size anus and regular bowel actions. There has been no rectal prolapse, or anal stricture. EAS activity and perineal proprioception were preserved postoperatively. Follow up computed tomogram showed central placement the pull through bowel in between the muscle complex. Conclusion The technique of SSARP allows safe and anatomical reconstruction in a significant proportion of patients with ARM's without the need to divide the levator plate and muscle complex. It preserves all the components contributing to superior faecal continence, and avoids the potential complications associated with the open posterior sagittal approach.

Pratap, Akshay; Tiwari, Awadhesh; Kumar, Anand; Adhikary, Shailesh; Singh, Satyendra Narayan; Paudel, Bishnu Hari; Bartaula, Rajiv; Mishra, Brijesh

2007-01-01

225

The internal anal sphincter in the cat: a study of nervous mechanisms affecting tone and reflex activity  

PubMed Central

1. Smooth muscle activities in rectum and internal anal sphincter have been recorded using intraluminal balloons. 2. Reflex activation of the sphincter, caused by distension of the rectum, has been assessed before and after various combinations of blocking drugs. 3. Responses to stimulation of hypogastric or sacral nerves, or to the administration of drugs with autonomic actions have been tested before and after various combinations of blocking drugs. 4. Results indicate that the tone of the internal anal sphincter is influenced by a number of neural mechanisms. These include motor pathways involving both ?-adrenergic and cholinergic mechanisms and inhibitory pathways involving both ?-adrenergic and non-adrenergic non-cholinergic mechanisms. 5. Cholinergic contractions of the sphincter were converted to relaxations after ?-adrenergic blockade. This indicates that the contractions are an indirect effect operating through an adrenergic reflex. Cholinergic relaxations may also be indirect and operate through reflex inhibition secondary to rectal contractions. 6. Sphincteric motor activity is controlled largely through ?-adrenergic mechanisms by adrenergic nerves acting directly on the muscle. ?-Adrenergic inhibitory mechanisms are thought to operate indirectly via ganglia. 7. The over-all control of the sphincter is by complex reflex mechanisms involving numerous pathways and the activity of the sphincter at any one time is determined by the net balance between motor and inhibitory influences. 8. Sacral nerve stimulation indicated that it contains cholinergic nerves to the rectum, non-adrenergic non-cholinergic inhibitory axons to the sphincter and variable numbers of adrenergic axons to the sphincter. 9. Responses of the sphincter to drugs and nerve stimulation were often variable, as has been described many times in the literature. It is considered that this is due to complex combinations of indirect reflex effects, secondary to activation of structures outside the sphincter, operating with or against direct effects on the sphincter itself.

Garrett, J. R.; Howard, E. R.; Jones, W.

1974-01-01

226

Primary repair of advanced obstetric anal sphincter tears: should it be performed by the overlapping sphincteroplasty technique?  

Microsoft Academic Search

Advanced obstetric anal sphincter tears are often associated with a high incidence of fecal and flatus incontinence. We aimed\\u000a to assess the clinical outcome of these repairs when done by the overlapping sphincteroplasty technique with reconstruction\\u000a of the internal anal sphincter and perineum. Between August 2005 and December 2006, all grades 3 and 4 obstetric anal sphincter\\u000a tears in our

Yoram Abramov; Beni Feiner; Thalma Rosen; Motti Bardichev; Eli Gutterman; Arie Lissak; Ron Auslander

2008-01-01

227

Effects of botulinum toxin A on the sphincter of Oddi: an in vivo and in vitro study  

Microsoft Academic Search

Background—Botulinum toxin A is a potent inhibitor of the release of acetylcholine from nerve endings. Local injection of botulinum toxin has recently been suggested to be helpful in sphincter of Oddi dyskinesia by decreasing sphincter of Oddi pressure.Aims—To explore the mechanism of action of botulinum toxin A on sphincter of Oddi (SO) muscle.Methods—Four piglets underwent duodenoscopy and SO manometry was

J Sand; I Nordback; P Arvola; I Pörsti; A Kalloo; P Pasricha

1998-01-01

228

The inhibitory role of nitric oxide in the control of porcine and human sphincter of Oddi activity  

Microsoft Academic Search

Background—The possible role of nitric oxide in the regulation of the sphincter of Oddi is not known in species with a resistor-like sphincter of Oddi such as humans and pigs.Methods—Sphincter of Oddi perfusion manometry and simultaneous electromyography (EMG) were recorded transduodenally in eight anaesthetised pigs. Acetylcholine (4 ?g\\/kg) was given intra-arterially, with or without sodium nitroprusside (10–100 ?g\\/kg), an exogenous

J Sand; P Arvola; V Jäntti; S Oja; C Singaram; G Baer; P J Pasricha; I Nordback

1997-01-01

229

Sphincter patency and hepatic BSP uptake after biliary sphincterotomy.  

PubMed Central

An attempt has been made to assess the patency and function of the choledochoduodenal junction after biliary sphincterotomy by estimating the first arrival time of injected bromsulphalein (BSP) in duodenal aspirate and the effect of morphine on this. Studies on 49 patients 1--12 years after this operation showed the arrival time to be normal in 47, but in 2 cases there was delay, which suggests that stenosis may develop in time in abot 4 per cent of cases. This had not been detected clinically, radiologically, or by liver function testing. Although it did not effect the BSP arrival time in T-tube bile, morphine was found to prolong the duodenal arrival time in control patients and also after sphincterotomy of the type used, indicating that the protective mechanism of the sphincter region may not have been destroyed by this operation. Abnormal BSP retention in plasma has been reported up to 5 years afte supraduodenal exploration of the bile ducts in 30 per cent of cases. Similarly, in the present study after biliary sphincterotomy plasma BSP levels were above normal in 14 of 49 patients, suggesting that this abnormality reflects the original pathological condition rather than the type of operation used to deal with it.

Peel, A. L.; Delvin, H. B.; Ritchie, H. D.

1975-01-01

230

Radial asymmetry characterized the upper esophageal sphincter pressures.  

PubMed

The characteristics of the upper esophageal sphincter (UES) motor functions remain unknown in Chinese. Twenty-three volunteers (M/F: 10/13, age: 19-40) without any pharyngeal/esophageal motor disturbance underwent UES measurement in the left decubitus position using a low compliance pneumohydraulic infusion system. These measurements included the location of UES from nostril, its resting pressure, and the responses to swallow. Mean UES resting pressures measured with three 120 degrees oriented manometric orifices were 22.6 +/- 7.7 mmHg, 16.9 +/- 8.6 mm Hg and 20.7 +/- 9.6 mmHg respectively (p < 0.05). In regard with the swallow-induced UES relax ability, the relax interval, the post-relax contractile amplitude and interval, neither dry swallow nor wet swallow led to a different result. Mean measured UES location from the nostril with the most proximal orifice of probe was 29.3 +/- 2.3 cm. This location did correlate very well with body height (r = 0.60, p < 0.01). In conclusion, this study demonstrates that the UES resting pressures exhibit a radial asymmetry, and that the type of swallow does not influence UES responses. Furthermore, an equation based on the body height may predict the most appropriate UES position. PMID:7796639

Lee, C T; Chang, F Y; Yeh, C L; Lee, S D

1994-01-01

231

Sacral Neuromodulation Effects on Periurethral Sensation and Urethral Sphincter Activity  

PubMed Central

Aims To characterize the effect of sacral neuromodulation (SNM) on urethral neuromuscular function. Methods Following IRB approval, women with refractory overactive bladder (OAB) underwent standardized urethral testing prior to and after stage 1 SNM implantation. Periurethral sensation was measured using current perception thresholds (CPT). Striated urethral sphincter activity was quantified using concentric needle electromyography (CNE) and Multi-Motor Unit Action Potential (MUP) analysis software. Nonparametric analyses were used to characterize pre/post changes with intervention. Baseline CPT and CNE findings were compared between SNM responders and non-responders. Results 27 women were enrolled in this pilot study with a mean age of 61±13 years. Twenty of 26 women (76.9%) responded to SNM and went to stage 2 permanent implantation. Four (14.8%) withdrew after stage 1 implantation; 3 of the 4 withdrawals had not had therapeutic responses to SNM. CPT and CNE parameters did not significantly differ from baseline 2 weeks after SNM. Pre-SNM urethral sensation was not significantly different between responders and non-responders. However, responders had larger amplitude, longer duration and more turns and phases at baseline approaching significance, reflecting more successful urethral reinnervation, than non-responders. Conclusions SNM does not alter urethral neuromuscular function two weeks post Stage 1implantation. Women with more successful urethral reinnervation may be more responsive to SNM.

Gleason, Jonathan L; Kenton, Kimberly; Greer, W. Jerod; Ramm, Olga; Szychowski, Jeff M.; Wilson, Tracey; Richter, Holly E.

2013-01-01

232

Combined Diagnostic Modalities Improve Detection of Detrusor External Sphincter Dyssynergia  

PubMed Central

Introduction. The diagnosis of detrusor-external sphincter dyssynergia (DESD) is a clinically relevant finding during urodynamic testing. However, there is no consensus regarding diagnostic specifics of electromyography (EMG) or voiding cystourethrography (VCUG). We evaluated the concordance of the two modalities most commonly used in clinical practice for the diagnosis of DESD. Methods. Patients were prospectively evaluated by a single urodynamicist at an academic center and retrospectively re-evaluated by an independent urodynamicist for agreement. DESD was determined by increased patch EMG activity or a dilated bladder neck/proximal urethra on VCUG during detrusor contraction. Minimal acceptable criterion for agreement was set at 70%. Results. Forty-six patients were diagnosed with DESD with both modalities available. Of these 46 patients, 25 were diagnosed by both tests, 11 by VCUG alone and 10 by patch EMG alone. Binomial testing demonstrated the proportion of agreement was 54% (95% CI 39% to 68%). Conclusion. We found significant disagreement between the two modalities, similar to previously reported findings using needle EMG, and we expand the applicability of our data to the majority of clinicians who use patch EMG electrodes. This further supports the idea that the combined use of EMG and VCUG for diagnosis can identify more cases of DESD than either modality alone.

Spettel, Sara; Kalorin, Carmin; De, Elise

2011-01-01

233

Role of alpha adrenoceptors in opossum internal anal sphincter.  

PubMed Central

The purpose of the present investigation was to examine the role of alpha adrenoceptors in the internal anal sphincter (IAS). Studies wer performed on alpha-chloralose anesthetized opossums. Resting pressure in the IAS (IASP) was recorded using low compliant continuously perfused catheters. The effects of the alpha-1 adrenoceptor agonist phenylephrine and alpha-2 adrenoceptor agonist clonidine and their corresponding selective antagonists, prazosin and yohimbine, respectively, were examined on the resting IASP, and on rectal balloon distension (RBD)-mediated IAS relaxation. Phenylephrine caused a rise in the IASP that was blocked by prazosin and not by yohimbine. Phenylephrine had no effect on IAS relaxation caused by RBD. Clonidine on the other hand caused significant suppression of IAS relaxation in response to RBD, but caused minimal changes in the resting IASP. The suppression of IAS relaxation by clonidine was selectively antagonized by yohimbine but not by prazosin. From these studies we conclude that alpha-2 adrenoceptors exert important neuromodulatory influences on rectoanal inhibitory reflex, while alpha-1 adrenoceptors may exert modulatory effects on the resting IAS tone.

Yamato, S; Rattan, S

1990-01-01

234

Cell-based therapy for the deficient urinary sphincter.  

PubMed

When sterile culture techniques of mammalian cells first became state of the art, there was tremendous anticipation that such cells could be eventually applied for therapeutic purposes. The discovery of adult human stem or progenitor cells further motivated scientists to pursue research in cell-based therapies. Although evidence from animal studies suggests that application of cells yields measurable benefits, in urology and many other disciplines, progenitor-cell-based therapies are not yet routinely clinically available. Stress urinary incontinence (SUI) is a condition affecting a large number of patients. The etiology of SUI includes, but is not limited to, degeneration of the urinary sphincter muscle tissue and loss of innervation, as well as anatomical and biomechanical causes. Therefore, different regimens were developed to treat SUI. However, at present, a curative functional treatment is not at hand. A progenitor-cell-based therapy that can tackle the etiology of incontinence, rather than the consequences, is a promising strategy. Therefore, several research teams have intensified their efforts to develop such a therapy for incontinence. Here, we introduce candidate stem and progenitor cells suitable for SUI treatment, show how the functional homogeneity and state of maturity of differentiated cells crucial for proper tissue integration can be assessed electrophysiologically prior to their clinical application, and discuss the trophic potential of adult mesenchymal stromal (or stem) cells in regeneration of neuronal function. PMID:23824516

Hart, Melanie L; Neumayer, Katharina M H; Vaegler, Martin; Daum, Lisa; Amend, Bastian; Sievert, Karl D; Di Giovanni, Simone; Kraushaar, Udo; Guenther, Elke; Stenzl, Arnulf; Aicher, Wilhelm K

2013-10-01

235

Anal sphincter electromyography: editing of sampled motor unit action potentials.  

PubMed

During multi-motor unit action potential (MUAP) analysis of the tonically contracted external anal sphincter (EAS), a mild interference pattern often obscures the baseline, affecting the algorithm's ability to determine accurate boundaries of detected MUAPs. To assess the equivalence of methods of editing and selecting candidate MUAPs from the EAS, 17 nulliparous women underwent concentric needle electromyography (EMG) of the EAS using multi-MUAP software. The selected MUAPs either were accepted without question ("automated"), or a subset was deleted due to a noisy baseline ("manual-deletion") or manually marked ("manual-mark"). A second examiner repeated the analysis. Each examiner found that the two editing methods were equivalent and yielded results that differed from those obtained by automated analysis of unedited data. However, there was a moderate difference in MUAP amplitude when the manual-deletion method was compared between the two examiners. Editing of selected EAS MUAPs during multi-MUAP analysis is required, and development of common protocols is essential to enable meaningful comparisons between similar studies. PMID:15468053

Gregory, W Thomas; Clark, Amanda L; Johnson, Joshua; Willis, Kimberly; Stuyvesant, Amy; Lou, Jau-Shin

2005-02-01

236

Vaginal stenosis and hydrometrocolpos: late complication of inadvertent perivaginal placement of an artificial urinary sphincter in prepubertal girls(1).  

PubMed

Urinary incontinence in pediatric and adolescent patients has been successfully managed with the artificial urinary sphincter for several decades. Placement of the sphincter can be difficult in the preadolescent girl due to poorly developed vaginal tissue that can result in difficulty establishing the surgical plane between the bladder and vagina. We report 2 patients in whom the sphincter was placed around the urethra and vagina, a complication that has been reported in only 1 patient previously. All 3 patients presented with hematometrocolpos and bloody vaginal discharge. All were successfully managed with replacement of the sphincter cuff around the urethra and delayed vaginoplasty. PMID:10754150

Cain, M P; Rink, R C

1999-11-01

237

Anal sphincteric neurogenic injury in asymptomatic nulliparous women and fecal incontinence  

PubMed Central

While anal sphincter neurogenic injury documented by needle electromyography (EMG) has been implicated to cause fecal incontinence (FI), most studies have been uncontrolled. Normal values and the effects of age on anal sphincter motor unit potentials (MUP) are ill defined. The functional significance of anal sphincter neurogenic injury in FI is unclear. Anal pressures and EMG were assessed in 20 asymptomatic nulliparous women (age, 38 ± 5 yr; mean ± SE) and 20 women with FI (54 ± 3 yr). A computerized program quantified MUP duration and phases. These parameters and MUP recruitment were also semiquantitatively assessed by experienced electromyographers in real time. Increasing age was associated with longer and more polyphasic MUP in nulliparous women by quantitative analysis. A higher proportion of FI patients had prolonged (1 control, 7 patients, P = 0.04) and polyphasic MUP (2 controls, 9 patients, P = 0.03) at rest but not during squeeze. Semiquantitative analyses identified neurogenic or muscle injury in the anal sphincter (11 patients) and other lumbosacral muscles (4 patients). There was substantial agreement between quantitative and semiquantitative analyses (? statistic 0.63 ± 95% CI: 0.32–0.96). Anal resting and squeeze pressures were lower (P ? 0.01) in FI than controls. Anal sphincter neurogenic or muscle injury assessed by needle EMG was associated (P = 0.01) with weaker squeeze pressures (83 ± 10 mmHg vs. 154 ± 30 mmHg) and explained 19% (P = 0.01) of the variation in squeeze pressure. Anal sphincter MUP are longer and more polyphasic in older than younger nulliparous women. Women with FI have more severe neurogenic or muscle anal sphincter injury, which is associated with lower squeeze pressures.

Daube, Jasper; Litchy, William; Traue, Julia; Edge, Jessica; Enck, Paul; Zinsmeister, Alan R.

2012-01-01

238

Characteristics of the internal anal sphincter and the rectum of the vervet monkey.  

PubMed

1. The physiology of the internal anal sphincter of the vervet monkey was investigated. 2. Strips of sphincter in vitro contracted to noradrenaline and adrenaline; adrenoceptors were mainly alpha-excitatory. Strips of rectal circular muscle relaxed to noradrenaline and contained both inhibitory alpha- and beta-adrenoceptors. 3. All strips contracted to acetylcholine. After hyoscine or atropine, high doses of acetylcholine relaxed all strips by stimulating intramural inhibitory neurones as relaxations were blocked by tetrodotoxin and hexamethonium. Nicotine and DMPP gave relaxations with similar characteristics. 4. It was concluded that relaxations to acetylcholine, nicotine and DMPP were not adrenergic as relaxations still occurred in strips from sympathetically denervated or reserpinized animals. The block of these relaxations by propranolol and guanethidine was considered to be unrelated to their actions as adrenergic blocking drugs. 5. All strips relaxed to field electrical stimulation (1--5 Hz) through stimulation of intramural inhibitory neurones as tetrodotoxin blocked these relaxations. Adrenergic blocking drugs, prior reserpinization or prior section of the hypogastric nerves did not block these responses. The relaxations were not therefore adrenergic. 6. 5-Hydroxytryptamine relaxed all strips but was not the transmitter in relaxations to acetylcholine, DMPP or nicotine, nor to field electrical stimulation, as desensitization of strips of 5-HT did not alter these responses. 7. The circular smooth muscle of the internal anal sphincter had a dense terminal adrenergic innervation which rapidly decreased orad. 8. In vivo, hypogastric nerve stimulation relaxed the rectum but contracted the sphincter. Sacral nerve root stimulation caused an after-contraction in both rectum and sphincter. In vivo, a close arterial injection of adrenaline or noradrenaline inhibited the spontaneous contraction waves of the rectum, but contracted the sphincter. Both these responses were blocked by phentolamine. 9. It was concluded that the internal anal sphincter is a discrete high pressure zone which was excitatory cholinergic and adrenergic innervations and an inhibitory non-adrenergic innervation. PMID:108393

Rayner, V

1979-01-01

239

[Botulinic toxin type a in combined treatment of males with chronic pelvic pain syndrome in combination with bladder emptying dysfunction].  

PubMed

The efficacy of various treatment of chronic pelvic pain syndrome in combination with bladder emptying dysfunction was comparatively analysed for 31 male patients. Statistics show that current schemes of medication including antibacterial, nonsteroid anti-inflammatory drugs, alpha-adrenoblockers are not highly effective in such patients. Transrectal microwave hyperthermia is effective in males with chronic pelvic pain syndrome but the response is short - 3 months maximum. The highest and the longest effect in patients with chronic pelvic pain syndrome in combination with bladder emptying dysfunction was achieved after injections of 100 units of botulinic toxin type A into the cross-striated sphincter of the urethra. PMID:22279792

Krivoborodov, G G; Shumilo, D V; Basil'ev, A V; Tur, E I; Poddubnaia, N V

2011-01-01

240

The effects of restraint on uptake of radioactive sulfate in the salivary and gastric secretions of rats with pyloric ligation  

NASA Technical Reports Server (NTRS)

The effects of restraint on the amount of nondialysable radioactive sulfate in the gastric wall and the gastric juice and saliva were investigated. It was found that restraint provokes a significant decrease in salivary radioactive sulfate. This, in turn, is responsible for the decrease of sulfate in the gastric contents observed under these conditions in rats with pyloric ligation. Esophageal ligation associated with this prevents passage of saliva and lowers the amount of radioactive sulfate in the gastric juice. Restraint causes then an increase in the amount of sulfate in the gastric juice, the value observed being very much lower than that of rats with a free esophagus. At the level of the gastric wall, the change observed during restraint does not reach a significant threshold.

Chayvialle, J. A.; Lambert, R.; Ruet, D.

1980-01-01

241

Eustachian Tube Dysfunction  

MedlinePLUS

MENU Return to Web version Eustachian Tube Dysfunction Overview What is eustachian tube dysfunction? The eustachian tubes are small passageways that connect the upper part of your throat (pharynx) ...

242

Effects of ethanol on the sphincter of Oddi: an endoscopic manometric study.  

PubMed Central

The effects of ethanol, given either intragastrically or intravenously, on the sphincter of Oddi was evaluated by endoscopic manometry. In 12 subjects intragastric ethanol (150 ml of 32%) was given over 10 minutes. In five control subjects saline solution (150 ml of 0.9%) was given intragastrically instead of ethanol. In five other subjects ethanol was infused intravenously (6 ml/kg of 10%) for 36 minutes. Ethanol given intragastrically produced a significant inhibitory effect on sphincter of Oddi pressure. Peak pressure fell from a control value of 75.7 +/- 26.35 mmHg to 39 +/- 15.39 mmHg (p less than 0.001) at 35 minutes. Basal pressure fell from a control value of 30.17 +/- 19.47 mmHg to 11.83 +/- 6.35 mmHg (p less than 0.01) at 35 minutes. Wave height fell from a control value of 41.33 +/- 15.4 mmHg to 27.16 +/- 11.25 mmHg (p less than 0.02) at 35 minutes. No effects on sphincter of Oddi wave frequency were observed. No significant modifications of sphincter motor activity were observed after intragastric saline infusion. Ethanol given intravenously also produced an appreciable inhibitory effect on sphincter of Oddi pressure, without affecting its wave frequency.

Viceconte, G

1983-01-01

243

The artificial bowel sphincter for faecal incontinence: a single centre study  

PubMed Central

Background and aims Faecal incontinence (FI) is a socially devastating problem. The treatment algorithm depends on the aetiology of the problem. Large anal sphincter defects can be treated by sphincter replacement procedures: the dynamic graciloplasty and the artificial bowel sphincter (ABS). Materials and methods Patients were included between 1997 and 2006. A full preoperative workup was mandatory for all patients. During the follow-up, the Williams incontinence score was used to classify the symptoms, and anal manometry was performed. Results Thirty-four patients (25 women) were included, of which, 33 patients received an ABS. The mean follow-up was 17.4 (0.8–106.3) months. The Williams score improved significantly after placement of the ABS (p?sphincter is an effective treatment for FI in patients with a large anal sphincter defect. Infectious complications are the largest threat necessitating explantation of the device.

Melenhorst, Jarno; Koch, Sacha M.; van Gemert, Wim G.

2007-01-01

244

Comparative study on the proteases from fish pyloric caeca and the use for production of gelatin hydrolysate with antioxidative activity.  

PubMed

Proteases from pyloric caeca extract of three fish species including brownstripe red snapper (Lutjanus vitta), bigeye snapper (Priacanthus tayenus) and threadfin bream (Nemipterus marginatus) were comparatively studied. The extracts from bigeye snapper and threadfin bream exhibited the highest hydrolytic activities toward casein, alpha-N-benzoyl-DL-arginine-p-nitroanilide and alpha-N-rho-tosyl-L-arginine methyl ester at pH 8.0 and 60 degrees C and pH 8.5 and 55 degrees C, respectively. The extract of brownstripe red snapper showed the optimal pH and temperature of 8.0 and 60 degrees C with all substrates used except the optimal temperature was 65 degrees C when casein was used. All proteases were strongly inhibited by soybean trypsin inhibitor (SBTI) and N-rho-tosyl-L-lysine chloromethylketone (TLCK) and partially inhibited by N-tosyl-L-phenylalanine chloromethylketone for all substrates tested, suggesting that trypsin-like proteases were the major enzymes. Substrate-gel activity staining of 40-60% ammonium sulfate (AS) fraction revealed that major activity bands were observed with molecular mass of 24, 22 and 20 kDa for brownstripe red snapper, bigeye snapper and threadfin bream, respectively. Those activity bands were partially inhibited by SBTI and TLCK. AS fraction was further used to produce gelatin hydrolysate from the skin of brownstripe red snapper with different degrees of hydrolysis (DH). Hydrolysate with DH of 15% exhibited the highest DPPH and ABTS radical scavenging activities and ferric reducing antioxidant power (p<0.05). Therefore, the extract from pyloric caeca could be used to produce the gelatin hydrolysates possessing antioxidative activities. PMID:18793744

Khantaphant, Sutheera; Benjakul, Soottawat

2008-12-01

245

Novel treatments of GERD: focus on the lower esophageal sphincter.  

PubMed

Up to 50% of patients with gastroesophageal reflux disease (GERD) still suffer from GERD symptoms despite proton pump inhibitor (PPI) therapy, indicating a need for new treatments. The lower esophageal sphincter (LES) plays a crucial role in maintaining the mechanical barrier necessary for prevention of gastric reflux. Transient LES relaxation (TLESR) is an important factor behind the occurrence of reflux, and preclinical studies have identified a number of targets for pharmacologic modification of TLESR. However, only gamma-aminobutyric acid (GABA) type B receptor (GABA(B)) agonists and metabotropic glutamate receptor 5 (mGluR5) modulators have shown positive proof of concept in the clinical setting. The mGluR5 negative allosteric modulator ADX10059 improved symptoms in GERD patients, but was associated with central side effects such as dizziness. Baclofen, a GABA(B) receptor agonist, reduces the incidence of TLESR and improves GERD symptoms in both adult and pediatric GERD patients. However, the utility of baclofen is similarly limited by poor tolerability and recent research has focused on the development of GABA(B) receptor agonists with improved tolerability. XP19986, a prodrug of R-baclofen, reduced the number of reflux episodes in a dose-ranging study and was similarly tolerated to placebo. AZD3355 and AZD9343 are GABA(B) receptor agonists with limited central nervous system activity that have been shown in preclinical studies to reduce the incidence of TLESR and decrease esophageal acid exposure; data from clinical studies of these agents in GERD patients are awaited with interest. Agents that target TLESR activity may therefore offer a promising new add-on treatment for patients who suffer from GERD symptoms despite PPI therapy. PMID:18924449

Lehmann, A

2008-08-01

246

Characterization of cholecystokinin receptors on the sphincter of Oddi.  

PubMed

To characterize directly the ability of cholecystokinin (CCK) to interact with receptors on the sphincter of Oddi (SO), we measured binding of 125I-labeled Bolton-Hunter-labeled COOH-terminal octapeptide of cholecystokinin (125I-BH-CCK-8) to tissue sections from the guinea pig SO. Autoradiography localized binding of 125I-BH-CCK-8 over the SO smooth muscle layer. Binding was saturable, specific, dependent on time, pH, and temperature, and was reversible. Binding of 125I-BH-CCK-8 was inhibited by various CCK receptor agonists with the following potencies: CCK-8 much greater than des(SO3)CCK-8 much greater than gastrin-17-I and by various CCK receptor antagonists with the following potencies: L-364,718 greater than proglumide analogue 10 much greater than carbobenzoxy-Tyr(SO3H)-Met-Gly-Trp-Met-Asp-NH2 greater than N2,O2' dibutyryl guanosine 3',5'-cyclic monophosphate. The potencies of agonists in stimulating and of antagonists in inhibiting CCK-8-stimulated SO contractions correlated closely with their abilities to inhibit binding of 125I-BH-CCK-8. Analysis of binding of 125I-BH-CCK-8 to SO tissue sections revealed two classes of CCK binding sites: a high-affinity site [dissociation constant (Kd) 0.2 nM] and a low-affinity site (Kd 70 nM). Atropine or tetrodotoxin (TTX) caused a similar rightward shift of the CCK-8 dose-response curve for stimulation of SO contraction. Comparison of receptor occupation to CCK-8-induced contraction suggested that CCK-8 occupation of the high-affinity binding site correlated with contraction in the absence of atropine and the low-affinity CCK binding with contraction in the presence of atropine or TTX.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2240227

Cox, K L; von Schrenck, T; Moran, T H; Gardner, J D; Jensen, R T

1990-11-01

247

Effects of Scleroderma Antibodies and Pooled Human Immunoglobulin on Anal Sphincter and Colonic Smooth Muscle Function  

PubMed Central

BACKGROUND & AIMS Patients with systemic sclerosis (SSc) have impairments in gastrointestinal smooth muscle function. The disorder has been associated with circulating antibodies to cholinergic muscarinic type-3 receptor (M3-R). We investigated whether it is possible to neutralize these antibodies with pooled human immunoglobulin (Ig)Gs (pooledhIgG). METHODS We studied the effects of IgGs purified from patients with SSc (SScIgGs) on cholinergic nerve stimulation in rat colon tissues. We also examined the effects of SScIgGs on M3-R activation by bethanechol (BeCh), M3-R occupancy, and receptor binding using mmunofluorescence, immunoblot, and ELISA analyses of human internal anal sphincter (IAS) smooth muscle cells (hSMCs), before and after administration of pooledhIgG. Functional displacement of M3-R occupancy by the SScIgGs was compared with that of other IgGs during the sustained phase of BeCh-induced contraction of intact smooth muscles from rats. RESULTS SScIgG significantly attenuated neutrally mediated contraction and acetylcholine release in rat colon as well as BeCh-induced sustained contraction of the IAS smooth muscle. In immunofluorescence analysis, SScIgG co-localized with M3-R. In immunoblot and ELISA analyses, M3-R loop-2 peptide and human IAS SMC membrane lysates bound significant amounts of SScIgG, compared with IgGs from healthy individuals and pooledhIgG. Binding was significantly attenuated by application of pooledhIgG, which by itself had no significant effect. Incubation of samples with pooledhIgG, or mixing pooledhIgG with SScIgG before administration to tissues, significantly reduced binding of SScIgG, indicating that pooledhIgG prevents SScIgG blockade of M3-R. CONCLUSIONS In studies of rat and human tissues, pooled human IgGs prevent and reverse the cholinergic dysfunctions associated with the progressive gastrointestinal manifestations of SSc, by neutralizing functional M3-R antibodies present in the circulation of patients with SSc.

SINGH, JAGMOHAN; COHEN, SIDNEY; MEHENDIRATTA, VAIBHAV; MENDOZA, FABIAN; JIMENEZ, SERGIO A.; DIMARINO, ANTHONY J.; RATTAN, SATISH

2012-01-01

248

The Onuf's nucleus and the external anal sphincter muscles in amyotrophic lateral sclerosis and Shy-Drager syndrome  

Microsoft Academic Search

The anterior sacral horns and external anal sphincter muscle were examined histologically with special reference to Onuf's nucleus in amyotrophic lateral sclerosis (ALS) and Shy-Drager syndrome. Onuf's nucleus and the external anal sphincter muscles were well preserved in ALS, but in Shy-Drager syndrome both structures showed marked degenerative changes. These findings suggest that Onuf's nucleus does not belong to the

T. Mannen; M. Iwata; Y. Toyokura; K. Nagashima

1982-01-01

249

Randomized trial of stent placed above and across the sphincter of Oddi in malignant bile duct obstruction  

Microsoft Academic Search

Background: Placement of stents above an intact sphincter of Oddi might prevent migration of bacteria and deposition of organic material into the stent. In patients with malignant obstructive jaundice prolongation of function time of the stent would be expected if it is placed above the sphincter of Oddi. Methods: Thirty-four patients were randomized to stent placement either above (n =

Finn Møller Pedersen; Annmarie Touborg Lassen; Ove B. Schaffalitzky de Muckadell

1998-01-01

250

Erectile dysfunction: management update  

PubMed Central

DRAMATIC ADVANCES IN THE MANAGEMENT of erectile dysfunction have occurred over the past decade. Oral therapy with vasoactive agents has emerged as first-line treatment and has transformed both the manner in which the public views erectile dysfunction and the way health care providers deliver care. Whereas an extensive investigation was previously common in the management of erectile dysfunction, recent treatment guidelines promote a more minimalist, goal-oriented approach. In this article, we review the physiology of erection, and the pathophysiology, diagnosis and clinical management of erectile dysfunction. We also present the existing evidence for the efficacy of 3 phosphodiesterase inhibitors, the most widely used class of agents for erectile dysfunction.

Fazio, Luke; Brock, Gerald

2004-01-01

251

Bladder Dysfunction in Mice with Experimental Autoimmune Encephalomyelitis  

PubMed Central

The vast majority of patients with multiple sclerosis (MS) develop bladder control problems including urgency to urinate, urinary incontinence, frequency of urination, and retention of urine. Over 60% of MS patients show detrusor-sphincter dyssynergia, an abnormality characterized by obstruction of urinary outflow as a result of discoordinated contraction of the urethral sphincter muscle and the bladder detrusor muscle. In the current study we examined bladder function in female SWXJ mice with different defined levels of neurological impairment following induction of experimental autoimmune encephalomyelitis (EAE), an animal model of central nervous system inflammation widely used in MS research. We found that EAE mice develop profound bladder dysfunction characterized by significantly increased micturition frequencies and significantly decreased urine output per micturition. Moreover, we found that the severity of bladder abnormalities in EAE mice was directly related to the severity of clinical EAE and neurologic disability. Our study is the first to show and characterize micturition abnormalities in EAE mice thereby providing a most useful model system for understanding and treating neurogenic bladder.

Altuntas, Cengiz Z.; Daneshgari, Firouz; Liu, Guiming; Fabiyi, Adebola; Kavran, Michael; Johnson, Justin M.; Gulen, M. Fatih; Jaini, Ritika; Li, Xiaoxia; Frenkl, Tara L.; Tuohy, Vincent K.

2009-01-01

252

An electromyographic study of the normal function of the external anal sphincter and pelvic diaphragm  

Microsoft Academic Search

Summary  The electrical activity of the external anal sphincter and puborectalis muscle of normal subjects has been investigated using\\u000a concentric needle electrodes.\\u000a \\u000a The activity in these muscles at rest, during voluntary and involuntary contractions and during defecation is described.\\u000a \\u000a \\u000a The findings show a delicate adjustment of activity to changing needs.\\u000a \\u000a \\u000a Variations in sphincter tone result from changes in the firing rate

D. Taverner; F. G. Smiddy

1959-01-01

253

Modeling of human colonic blood flow for a novel artificial anal sphincter system*  

PubMed Central

A novel artificial anal sphincter system has been developed to simulate the normal physiology of the human anorectum. With the goal of engineering a safe and reliable device, the model of human colonic blood flow has been built and the relationship between the colonic blood flow rate and the operating occlusion pressure of the anorectum is achieved. The tissue ischemia is analyzed based on constitutive relations for human anorectum. The results suggest that at the planned operating occlusion pressure of less than 4 kPa the artificial anal sphincter should not risk the vascularity of the human colon.

Zan, Peng; Yan, Guo-zheng; Liu, Hua

2008-01-01

254

Location of bladder and urethral sphincter motoneurons in the male guinea pig (Cavia porcellus).  

PubMed

Although the guinea pig is used widely in experimental medical research, including in studies on micturition control, the spinal origin of preganglionic parasympathetic bladder and somatic external urethral sphincter motoneurons is not known. In the male guinea pig using wheat germ agglutinin-conjugated horseradish peroxidase and dextran Alexa Fluor 488/568 tracers, preganglionic parasympathetic bladder motoneurons were observed in the ventrolateral part of the intermediolateral cell group of the first sacral segment. The external urethral sphincter motoneurons were found to be located in the ventral horn of the first sacral segment, in a cell group corresponding with the nucleus of Onuf in cat and human. PMID:15147780

Kuipers, Rutger; Izhar, Zofiet; Gerrits, Peter O; Miner, Wesley; Holstege, Gert

2004-05-13

255

Sphincter saving surgery is the standard procedure for treatment of low rectal cancer.  

PubMed

Carcinoma rectum is a challenging problem both for the developed and underdeveloped countries. Colorectal cancer accounts for 9% of all cancer deaths (49,920) in 2009 in USA. Carcinoma involving the lower part of the rectum is now successfully managed by sphincter saving surgery with less morbidity and uneventful recovery. To observe the objective, subjective and functional outcome of the patients suffering from cancer of the lower third of the rectum managed by surgical intervention with preservation of sphincter. A comparative study was carried out on 54 patients with low rectal cancer who underwent ultra-low anterior resection in the department of surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2009 to December 2010. Patients were divided into two groups depending on the tumor distance from anal verge. Thirty one (57%) patients were in Group A (Experimental) where tumor distance was 5cm from anal verge and upper 1cm of anal sphincter was sacrificed during surgical intervention. Twenty three (43%) patients were in Group B (Control) where tumor distance was 6cm from anal verge and whole length (4cm) of anal sphincter was preserved during surgical intervention. Functional integrity of anal sphincter was assessed between these two groups of patients following surgery. The mean age of the patients was 45.96±14.41 years. During surgery, ultra low anterior resection was performed to remove the tumor in all patients and for anastomosis double stapling technique was performed in 52(96%) patients and hand sewn technique was performed in 2(4%) patients irrespective of tumor distance from anal verge. Covering ileostomy was fashioned in all but one patient. During post-operative follow up anal sphincter muscle tone, anal sphincter function (Anal continence, p = 0.54), Quality of life (Social life, p = 0.54; Professional life, p = 0.23; House work and Need a diaper, p = 0.54) were not significantly impaired in both groups. Functional outcome of anal sphincter muscle and quality of life was not impaired in comparison to general population after low rectal cancer surgery. PMID:23715349

Rahman, M S; Khair, M A; Khanam, F; Haque, S; Alam, M K; Haque, M M; Salam, M A; Sikder, A H

2013-04-01

256

Bowel dysfunction in spinal cord injury: current perspectives.  

PubMed

Permanent disruptions of gastrointestinal function are very common sequel of spinal cord injury (SCI). When motor and sensory nervous integrity are severely affected, neurogenic gastrointestinal dysfunction is an inevitable consequence. Autonomic nervous system miss function has significantly diminished or lost sensory sensations followed with incomplete evacuation of stool from the rectal vault, immobility, and reduced anal sphincter tone all of those predisposing to increased risk of fecal incontinence (FI). The FI is, beside paralysis of extremities, one of the symptoms most profoundly affecting quality of life (QOL) in patients with SCI. We are reviewing current perspectives in management of SCI, discussing some pathophysiology mechanisms which could be addressed and pointing toward actual practical concepts in use for evaluation and improvements necessary to sustain SCI patients QOL. PMID:24549854

Pan, Yuehai; Liu, Bin; Li, Ruijun; Zhang, Zhixin; Lu, Laijin

2014-07-01

257

Muscle-Derived Cells for Treatment of Iatrogenic Sphincter Damage and Urinary Incontinence in Men  

PubMed Central

Introduction. Aim of this study was to assess the safety and efficacy of injection of autologous muscle-derived cells into the urinary sphincter for treatment of postprostatectomy urinary incontinence in men and to characterize the injected cells prior to transplantation. Methods. 222 male patients with stress urinary incontinence and sphincter damage after uroloical procedures were treated with transurethral injection of autologous muscle-derived cells. The transplanted cells were investigated after cultivation and prior to application by immunocytochemistry using different markers of myogenic differentiation. Feasibility and functionality assessment was achieved with a follow-up of at least 12 months. Results. Follow-up was at least 12 months. Of the 222 treated patients, 120 responded to therapy of whom 26 patients (12%) were continent, and 94 patients (42%) showed improvement. In 102 (46%) patients, the therapy was ineffective. Clinical improvement was observed on average 4.7 months after transplantation and continued in all improved patients. The cells injected into the sphincter were at least ~50% of myogenic origin and representative for early stages of muscle cell differentiation. Conclusions. Transurethral injection of muscle-derived cells into the damaged urethral sphincter of male patients is a safe procedure. Transplanted cells represent different phases of myogenic differentiation.

Gerullis, H.; Eimer, C.; Georgas, E.; Homburger, M.; El-Baz, A. G.; Wishahi, M.; Boros, M.; Ecke, T. H.; Otto, T.

2012-01-01

258

Topical diltiazem and bethanechol decrease anal sphincter pressure and heal anal fissures without side effects  

Microsoft Academic Search

PURPOSE: Topical glyceryl trinitrate heals anal fissures, but a majority of patients experience headache. Topical gels of the calcium channel blocker diltiazem and the cholinomimetic bethanechol significantly lower and sphincter pressure in volunteers. This study investigated the use of these two new pharmacologic agents in the treatment of patients with chronic anal fissure. METHODS: Two studies were conducted, each involving

Emin A. Carapeti; Michael A. Kamm; Robin K. S. Phillips

2000-01-01

259

Alteration of the upper esophageal sphincter belch reflex in patients with achalasia.  

PubMed

Some patients with achalasia have been reported to develop airway obstruction from a massively air-distended esophagus, which may represent an abnormality in the upper esophageal sphincter belch reflex. When questioned carefully, 95% of our achalasia patients reported difficulty with belching. The upper esophageal belch reflex in 23 consecutive achalasia patients and 12 healthy controls was studied using an upper esophageal sphincter sleeve manometry catheter and rapid injection of 20-50 mL of air into the midesophagus. Compared with normal subjects, achalasia patients were significantly less likely to have an esophageal belch for all volumes tested and were more likely to have an increase rather than a decrease in upper esophageal sphincter pressure in response to air injection. This study systematically documents that many achalasia patients have an alteration in the upper esophageal sphincter belch reflex that may be a contributory mechanism for some of the chest and upper airway symptoms reported by some patients during acute esophageal distension. PMID:1426877

Massey, B T; Hogan, W J; Dodds, W J; Dantas, R O

1992-11-01

260

A comparison between electromyography and anal endosonography in mapping external anal sphincter defects  

Microsoft Academic Search

Mapping of the external anal sphincter by anal endosonography was compared with the electromyographic findings in 15 patients with fecal incontinence after perineal trauma. Both examinations showed no defect in three patients. In the 12 patients with muscle defects, there was agreement on the quadrant involved in all patients. In seven patients, there was total agreement in the hours of

Penelope J. Law; M. A. Kamm; C. I. Bartram

1990-01-01

261

Mini-invasive collagen sling in the treatment of urinary incontinence due to sphincteric incompetence  

Microsoft Academic Search

Objective: To assess the technical feasibility of mini-invasive sling procedure and present preliminary results in the treat- ment of urinary incontinence due to sphincteric insufficiency. Materials and Methods: Thirteen patients (6 males, 7 females, 8 with myelomeningocele, 1 with tethered spinal cord, 3 with bladder exstrophy, 1 with epispadias) underwent sling procedure with porcine dermis acellular collagen matrix (Pelvilace?, Bard

Seppo Taskinen; Riitta Fagerholm; Risto Rintala

2007-01-01

262

The artificial urinary sphincter in the female: Indications for use, surgical approach and results  

Microsoft Academic Search

Female urinary incontinence is a common problem. Among the many treatment options a few patients may be suitable candidates for the artificial urinary sphincter (AUS). The indications for placement of an AUS are much more common in males: however, we review the indications, technique and potential complications of the AUS in the female population. Although few indications exist for the

D. S. Elliott; D. M. Barrett

1998-01-01

263

Endoanal MRI of the anal sphincter complex: correlation with cross-sectional anatomy and histology.  

PubMed Central

The purpose of this study was to correlate the in vivo endoanal MRI findings of the anal sphincter with the cross-sectional anatomy and histology. Fourteen patients with rectal tumours were examined with a rigid endoanal MR coil before undergoing abdominoperineal resection. In addition, 12 cadavers were used to obtain cross-sectional anatomical sections. The images were correlated with the histology and anatomy of the resected rectal specimens as well as with the cross-sectional anatomical sections of the 12 cadavers. The findings in 8 patients, 11 rectal preparations, and 10 cadavers, could be compared. In these cases, there was an excellent correlation between endoanal MRI and the cross-sectional cadaver anatomy and histology. With endoanal MRI, all muscle layers of the anal canal wall, comprising the internal anal sphincter, longitudinal muscle, the external anal sphincter and the puborectalis muscle were clearly visible. The levator ani muscle and ligamentous attachments were also well demonstrated. The perianal anatomical spaces, containing multiple septae, were clearly visible. In conclusion, endoanal MRI is excellent for visualising the anal sphincter complex and the findings show a good correlation with the cross-sectional anatomy and histology. Images Fig. 1 Fig. 2

Hussain, S M; Stoker, J; Zwamborn, A W; Den Hollander, J C; Kuiper, J W; Entius, C A; Lameris, J S

1996-01-01

264

Phosphodiesterase Inhibitors Cause Relaxation of the Internal Anal Sphincter In Vitro  

Microsoft Academic Search

PURPOSE: Pharmacologic treatments are gaining widespread acceptance as first-line therapy for anal fissure. However, existing treatments have limited clinical usefulness because of side effects and incomplete healing rates. METHODS: Fresh human surgical resection specimens containing internal anal sphincter and rectal circular muscle were collected. Strips of smooth muscle were cut from each muscle group and mounted in a superfusion organ

Oliver M. Jones; Alison F. Brading; Neil J. Mc C. Mortensen

2002-01-01

265

Effects of transdermal nicotine on lower esophageal sphincter and esophageal motility  

Microsoft Academic Search

Cigarette smoking has been shown to decrease lower esophageal sphincter pressure (LESP) by 19–42%. This decrease in LESP may be due to nicotine in the cigarette smoke or substances other than nicotine. The aim of this study was to evaluate the effects of a nicotine patch on esophageal motility since nicotine patches are devoid of all toxins present in the

Shailesh C. Kadakia; Henry Renom De la Baume; Richard T. Shaffer

1996-01-01

266

Current Evaluation of Upper Oesophageal Sphincter Opening in Dysphagia Practice: An International SLT Survey  

ERIC Educational Resources Information Center

Background: The assessment of adequate upper oesophageal sphincter (UOS) opening during swallowing is an integral component of dysphagia evaluation. Aims: To ascertain speech and language therapists' (SLTs) satisfaction with current methods for assessing UOS function in people with dysphagia and to identify challenges encountered by SLTs with UOS…

Regan, Julie; Walshe, Margaret; McMahon, Barry P.

2012-01-01

267

Management of upper esophageal sphincter disorders: indications and complications of myotomy  

Microsoft Academic Search

Since 1951, when it was first used as a treatment for post-poliomyelitis dysphagia, cricopharyngeal myotomy (CPM) has been used in the treatment of various neurogenic, myogenic, structural, and idiopathic disorders. Yet, the efficacy of CPM in treating patients with upper esophageal sphincter (UES) disorders remains controversial. Despite favorable reports regarding its success, too few studies about indications, complications, and outcomes

James H Kelly

2000-01-01

268

Tripod Modification of Sphincter Corer: Construction, Operation, Core Extrusion and Sampling Efficiency.  

National Technical Information Service (NTIS)

A 21-cm diameter sphincter corer has been modified by mounting it in a tripod frame. This modification results in more dependable recovery of undisturbed surficial sediment and greater penetration into firm sediment. The device is useful in water depths f...

J. C. Burke S. A. Casso R. E. Hamblin

1983-01-01

269

Influence of rectal prolapse on the asymmetry of the anal sphincter in patients with anal incontinence  

Microsoft Academic Search

BACKGROUND: Anal sphincter defects have been shown to increase pressure asymmetry within the anal canal in patients with fecal incontinence. However, this correlation is far from perfect, and other factors may play a role. The goal of this study was to assess the impact of rectal prolapse on anal pressure asymmetry in patients with anal incontinence. METHODS: 44 patients, (42

Henri Damon; Luc Henry; Sabine Roman; Xavier Barth; François Mion

2003-01-01

270

Local transdermal delivery of phenylephrine to the anal sphincter muscle using microneedles  

PubMed Central

We propose pretreatment using microneedles to increase perianal skin permeability for locally targeted delivery of phenylephrine (PE), a drug that increases resting anal sphincter pressure to treat fecal incontinence. Microneedle patches were fabricated by micromolding poly-lactic-acid. Pre-treatment of human cadaver skin with microneedles increased PE delivery across the skin by up to 10-fold in vitro. In vivo delivery was assessed in rats receiving treatment with or without use of microneedles and with or without PE. Resting anal sphincter pressure was then measured over time using water-perfused anorectal manometry. For rats pretreated with microneedles, topical application of 30% PE gel rapidly increased the mean resting anal sphincter pressure from 7 ± 2 cm H2O to a peak value of 43 ± 17 cm H2O after 1 h, which was significantly greater than rats receiving PE gel without microneedle pretreatment. Additional safety studies showed that topically applied green fluorescent protein–expressing E. coli penetrated skin pierced with 23- and 26-gauge hypodermic needles, but E. coli was not detected in skin pretreated with microneedles, which suggests that microneedle-treated skin may not be especially susceptible to infection. In conclusion, this study demonstrates local transdermal delivery of PE to the anal sphincter muscle using microneedles, which may provide a novel treatment for fecal incontinence.

Baek, Changyoon; Han, MeeRee; Min, Junghong; Prausnitz, Mark R.; Park, Jung-Hwan; Park, Jungho

2014-01-01

271

Incidence of pancreatitis in patients undergoing sphincter of Oddi manometry (SOM)  

Microsoft Academic Search

Objective:Sphincter of Oddi manometry (SOM) is a useful diagnostic procedure when evaluating patients with unexplained biliary pain or idiopathic recurrent pancreatitis. Acute pancreatitis is a recognized complication of SOM whose pathogenesis appears to be multifactoral. We conducted this study to determine the incidence of pancreatitis in patients after SOM and to identify any variables that may lead to an increased

Martin E. Maldonado; Patrick G. Brady; Jay J. Mamel; Bruce Robinson

1999-01-01

272

RESPONSE OF EXTERNAL URETHRAL SPHINCTER TO HIGH FREQUENCY BIPHASIC ELECTRICAL STIMULATION OF PUDENDAL NERVE  

Microsoft Academic Search

PurposeWe optimized the axonal blocking effect of high frequency, biphasic stimulation on neurally evoked contractions of the external urethral sphincter (EUS) and further investigated the repeatability of the blocking effect during relatively long periods to evaluate any acute nerve damage.

CHANGFENG TAI; JAMES R. ROPPOLO; WILLIAM C. de GROAT

2005-01-01

273

Origins and courses of the nervous branches to the male urethral sphincter  

Microsoft Academic Search

The striated sphincter of the male urethra, the so-called rhabdosphincter, contributes significantly to urethral closure pressure. It is generally agreed that the somatic nerve fibers from the pudendal nerve innervate the rhabdosphincter, and the autonomic nerve fibers innervate the smooth muscle of the urethra. Although it is difficult to clearly identify the rhabdosphincter macroscopically, we minutely investigated the nerve branches

K. Akita; H. Sakamoto; T. Sato

2003-01-01

274

BLOCK OF EXTERNAL URETHRAL SPHINCTER CONTRACTION BY HIGH FREQUENCY ELECTRICAL STIMULATION OF PUDENDAL NERVE  

Microsoft Academic Search

Purpose:High frequency electrical stimulation (1 to 10 kHz) of the pudendal nerve was evaluated as a method to block the external urethral sphincter contractions and increases in intraurethral pressure induced by electrical stimulation of pudendal nerve efferent axons.

CHANGFENG TAI; JAMES R. ROPPOLO; WILLIAM C. de GROAT

2004-01-01

275

Incidence of pancreatitis in patients undergoing sphincter of Oddi manometry (SOM)  

Microsoft Academic Search

Objective: Sphincter of Oddi manometry (SOM) is a useful diagnostic procedure when evaluating patients with unexplained biliary pain or idiopathic recurrent pancreatitis. Acute pancreatitis is a recognized complication of SOM whose pathogenesis appears to be multifactoral. We conducted this study to determine the incidence of pancreatitis in patients after SOM and to identify any variables that may lead to an

Martin E Maldonado; Patrick G Brady; Jay J Mamel; Bruce Robinson

1999-01-01

276

Dilated common duct sign. A potential indicator of a sphincter of Oddi dyskinesia  

SciTech Connect

The cholescintigraphic findings of a Sphincter of Oddi dyskinesia (SOD) in a 45-year-old woman with persistent right upper quadrant pain and biliary colic are reported. After an overnight fast, the patient was injected with 5 mCi of Tc-99 disofenin and .02 micrograms/kg of cholecystokinin (CCK) post maximal gallbladder filling. Pre and postcholescintiscans were obtained and gallbladder ejection fractions determined. The hepatobiliary scan was normal, except for a delay in biliary-bowel transit. The gallbladder responded normally to CCK, however, the Sphincter of Oddi responded abnormally, as there was a paradoxical response to CCK manifested by a marked dilatation of the common bile duct. It was postulate that this dilatation (the dilated common duct sign) was due to an inappropriate response of the smooth muscle of the Sphincter of Oddi (contraction vs relaxation) to CCK and was the cause of this patient's biliary colic. The dilated common duct sign should alert the physician to the possibility of a Sphincter of Oddi dyskinesia.

DeRidder, P.; Fink-Bennett, D.

1984-05-01

277

Effect of glyceryl trinitrate on the sphincter of Oddi motility and baseline pressure  

Microsoft Academic Search

It is widely accepted that glyceryl trinitrate (GTN) effectively dilates the smooth muscles of blood vessels. A similar effect has been postulated on the smooth muscles in the gastrointestinal tract. In this study the motility of the sphincter of Oddi and the common bile duct pressure as determined by endoscopic manometry was investigated in nine patients before and after sublingual

M Staritz; T Poralla; K Ewe; K H Meyer zum Büschenfelde

1985-01-01

278

Neuropeptides in pig sphincter of Oddi, bile duct, gallbladder, and duodenum  

Microsoft Academic Search

To better understand the complex structure and function of the sphincter of Oddi (SO), the occurrence and localization of nine neuropeptides, including vasoactive intestinal polypeptide (VIP), bombesin, neuropeptide Y, peptide histidine-isoleucine (PHI), calcitonin gene-related peptide (CGRP), galanin, substance P, serotonin, and somatostatin, were studied by immunohistochemical methods in the pig SO. The SO innervation was compared to gallbladder, common bile

Juhani Sand; Hanna Tainio; Isto Nordback

1993-01-01

279

Treatment of recurrent high anal fistula by total excision and primary sphincter reconstruction  

Microsoft Academic Search

Fourteen patients with recurrent high anal fistula were treated by total excision of the fistulous tract with primary sphincter reconstruction. Nine patients with sepsis had seton drainage for one to three months before the operation. The surgical approach was the transsphincteric technique described by Mason. No covering stoma was used routinely, but three patients referred with a colostomy had the

J. Christiansen; C. Rønholt

1995-01-01

280

Hyperuricemia induces endothelial dysfunction  

Microsoft Academic Search

Hyperuricemia induces endothelial dysfunction.BackgroundHyperuricemia has been linked to cardiovascular and renal diseases, possibly through the generation of reactive oxygen species (ROS) and subsequent endothelial dysfunction. The enzymatic effect of xanthine oxidase is the production of ROS and uric acid. Studies have shown that inhibiting xanthine oxidase with allopurinol can reverse endothelial dysfunction. Furthermore, rat studies have shown that hyperuricemia-induced hypertension

Uday M. Khosla; SERGEY ZHARIKOV; Jennifer L. Finch; TAKAHIKO NAKAGAWA; CARLOS RONCAL; WEI MU; KARINA KROTOVA; Edward R. Block; SHARMA PRABHAKAR; Richard J. Johnson

2005-01-01

281

Functional outcome after anal sphincter injury and treatment with mesenchymal stem cells.  

PubMed

This research demonstrates the regenerative effects of mesenchymal stem cells (MSCs) on the injured anal sphincter by comparing anal sphincter pressures following intramuscular and serial intravascular MSC infusion in a rat model of anal sphincter injury. Fifty rats were divided into injury (n = 35) and no injury (NI; n = 15) groups. Each group was further divided into i.m., serial i.v., or no-treatment (n = 5) groups and followed for 5 weeks. The injury consisted of an excision of 25% of the anal sphincter complex. Twenty-four hours after injury, 5 × 10(5) green fluorescent protein-labeled MSCs in 0.2 ml of phosphate-buffered saline (PBS) or PBS alone (sham) were injected into the anal sphincter for i.m. treatment; i.v. and sham i.v. treatments were delivered daily for 6 consecutive days via the tail vein. Anal pressures were recorded before injury and 10 days and 5 weeks after treatment. Ten days after i.m. MSC treatment, resting and peak pressures were significantly increased compared with those in sham i.m. treatment (p < .001). When compared with the NI group, the injury groups had anal pressures that were not significantly different 5 weeks after i.m./i.v. treatment. Both resting and peak pressures were also significantly increased after i.m./i.v. MSC treatment compared with treatment with PBS (p < .001), suggesting recovery. Statistical analysis was done using paired t test with Bonferroni correction. Marked decrease in fibrosis and scar tissue was seen in both MSC-treated groups. Both i.m. and i.v. MSC treatment after injury caused an increase in anal pressures sustained at 5 weeks, although fewer cells were injected i.m. The MSC-treated groups showed less scarring than the PBS-treated groups, with the i.v. infusion group showing the least scarring. PMID:24797828

Salcedo, Levilester; Penn, Marc; Damaser, Margot; Balog, Brian; Zutshi, Massarat

2014-06-01

282

Effects of thienorphine on contraction of the Guinea pig sphincter of Oddi, choledochus and gall bladder.  

PubMed

Opioid analgesics are widely believed to cause spasm of the bile duct sphincter and so impede bile flow. Thienorphine is a partial opioid agonist that is a good candidate for the treatment of opioid dependence; however, to date, no studies have reported the effects of thienorphine on the function of the biliary tract. This study examined the in vivo effects of thienorphine on the guinea pig isolated sphincter of Oddi, choledochus and gall bladder and on bile flow. The area under the curve (AUC) of isolated sphincter of Oddi was not influenced by thienorphine or buprenorphine, whereas morphine increased the AUC of the isolated sphincter of Oddi in a concentration-dependent manner. Thienorphine and buprenorphine concentration-dependently decreased the AUC of isolated choledochus, while morphine increased the AUC of isolated choledochus. Thienorphine had no effect on the contractile amplitude or basal tension of isolated gall bladder muscle strips. In contrast, buprenorphine and morphine increased the contractile basal tension of isolated gall bladder muscle strips in a concentration-dependent manner. Thienorphine (0.01-1.0mg/kg) had no significant inhibitory effect on bile flow. However, morphine (1.0-10mg/kg) and buprenorphine (1.0mg/kg) significantly inhibited bile flow. The maximum inhibition of bile flow by buprenorphine was 63.9±12.9% and by morphine was 74.1±11.3%. In summary, thienorphine has little influence on the guinea pig isolated sphincter of Oddi, choledochus and gall bladder or on bile flow, which may result in a lack of adverse biliary colic effects. PMID:24830319

Zhou, Peilan; Li, Tingting; Su, Ruibin; Gong, Zehui

2014-08-15

283

Free microneurovascular gracilis muscle transfer in the dog for enterostomal sphincter construction and control: an experimental study.  

PubMed

Hundreds of thousands of individuals struggle today with the morbidity of an abdominal wall enterostoma. This study explored two ways of constructing abdominal wall sphincter mechanisms in dogs using gracilis muscles transferred by free microneurovascular technique. Transferred muscles successfully generated pressures greater than the normal external anal sphincter but could not maintain this level of contraction for tonic sphincter closure. Other transferred muscles were designed to straighten the course of stomas continent at rest. They provided strong linear pull uncoiling the stomas but simultaneously pinched off the orifices during contraction. This opening model shows promise if the muscle attachments around the stoma orifices could be made less constricting. PMID:2978825

Merrell, J C; Russell, R C; Zook, E G

1986-07-01

284

cDNA cloning and sequencing of phospholipase A2 from the pyloric ceca of the starfish Asterina pectinifera.  

PubMed

Three cDNA from the pyloric ceca of the starfish Asterina pectinifera, (namely, cDNA 1, 2, and 3), encoding phospholipase A2 (PLA2), were isolated and sequenced. These cDNAs were composed of 415 bp with an open reading frame of 414 bp at nucleotide positions 1-414, which encodes 138 amino acids including N-terminal Met derived from the PCR primer. The amino acid sequence deduced from the cDNA 1 was completely consistent with the sequence determined with the starfish PLA2 protein, while those deduced from cDNA 2 and cDNA 3 differed at one and twelve amino acid residual positions, respectively, from the sequence of the PLA2 protein, suggesting the presence of multiple forms in the starfish PLA2. All of the sequences deduced from cDNA 1, 2, and 3 required two amino acid deletions in pancreatic loop region, and sixteen insertions and three deletions in beta-wing region when aligned with the sequence of mammalian pancreatic PLA2. In phylogenetic tree, the starfish PLA2 should be classified into an independent group, but hardly to the established groups IA and IB. The characteristic structure in the pancreatic loop and beta-wing regions may account for the specific properties of the starfish PLA2, e.g. the higher activity and characteristic substrate specificity compared with commercially available PLA2 from porcine pancreas. PMID:11026670

Kishimura, H; Ojima, T; Hayashi, K; Nishita, K

2000-08-01

285

Upper GI tract lesions in familial adenomatous polyposis (FAP): enrichment of pyloric gland adenomas and other gastric and duodenal neoplasms.  

PubMed

Patients with familial adenomatous polyposis (FAP), an autosomal dominant cancer predisposition syndrome caused by mutations in the APC gene, develop neoplasms in both the upper and lower gastrointestinal (GI) tract. To clarify the upper GI tract lesions in FAP patients in a tertiary care setting, we reviewed specimens from 321 endoscopies in 66 patients with FAP. Tubular adenomas in the small bowel were the most common neoplasms (present in 89% of patients), although only 1 patient developed invasive carcinoma of the small bowel. Several types of gastric neoplasms were identified--65% of patients had at least 1 fundic gland polyp, and 23% of patients had at least 1 gastric foveolar-type gastric adenoma. Pyloric gland adenomas were also enriched, occurring in 6% of patients--this is a novel finding in FAP patients. Despite the high frequency of gastric neoplasms, only 1 patient developed carcinoma in the stomach. The very low frequency of carcinoma in these patients suggests that current screening procedures prevent the vast majority of upper GI tract carcinomas in patients with FAP, at least in the tertiary care setting. PMID:24525509

Wood, Laura D; Salaria, Safia N; Cruise, Michael W; Giardiello, Francis M; Montgomery, Elizabeth A

2014-03-01

286

Erectile Dysfunction (ED): Surgical Management  

MedlinePLUS

... amet, consectetur adipiscing elit. Erectile Dysfunction (ED): Surgical Management View PDFs of our " Treating Erectile Dysfunction: Medical ... more information? ED: Penile Protheses ED: Non-Surgical Management Hormone Health Network's Erectile Dysfunction Fact Sheet Urology ...

287

Transurethral Implantation of Macroplastique® for the Treatment of Female Stress Urinary Incontinence Secondary to Urethral Sphincter Deficiency  

Microsoft Academic Search

Objective: To assess the results of transurethral implantation of Macroplastique® in women with stress incontinence secondary to urethral sphincter deficiency using subjective and objective outcome measures.Methods: A total of 60 women with genuine stress incontinence secondary to intrinsic urethral sphincter deficiency were treated with transurethral implantation of Macroplastique. The patients had undergone a mean of 1.9 (range 0–7) previous episodes

S. C. Radley; C. R. Chapple; I. C. Mitsogiannis; K. S. Glass

2001-01-01

288

Response of the human cardia sphincter to circulating prostaglandins F2ALPHA and E2 and to antiinflammatory drugs.  

PubMed

The effects on intraluminal pressure in the oesophagus, the cardiac sphincter, and the gastric fundus of intravenous prostaglandin F2alpha, E2, And of rectal indomethacin were studies in 41 subjects. Intravenous infusion of prostaglandin F2alpha (0-05 to 0-8 mug kg-minus1) produced marked, dose-related and sustained elevation of cardiac sphincter pressure without significantly affecting oesophageal peristalsis or gastric fundal motility. Sphincteric relaxation during swallowing was prolonged. Plasma gastrin levels were unchanged. Intravenous infusion of PGE2 (0-08 mug kg-minus1 min-minus) inhibited sphincter contractions to serial bolus intravenous injections of pentagastrin (0-1 or 0-2 mug kg-minus 1). Rectal indomethacin (200 mg) resulted in a riseof cardiac sphincter pressure, suggesting that endogenous synthesis of an inhibitory (E-type) prostaglandin was suppressed. The results indicate that prostaglandin E2 may be concerned in the regulation of cardiac sphincter tone in man, whilst prostaglandin F2alpha may be useful in the treatment of gastrooesphageal reflux. PMID:1126663

Dilawari, J B; Newman, A; Poleo, J; Misiewicz, J J

1975-02-01

289

Response of the human cardia sphincter to circulating prostaglandins F2ALPHA and E2 and to antiinflammatory drugs.  

PubMed Central

The effects on intraluminal pressure in the oesophagus, the cardiac sphincter, and the gastric fundus of intravenous prostaglandin F2alpha, E2, And of rectal indomethacin were studies in 41 subjects. Intravenous infusion of prostaglandin F2alpha (0-05 to 0-8 mug kg-minus1) produced marked, dose-related and sustained elevation of cardiac sphincter pressure without significantly affecting oesophageal peristalsis or gastric fundal motility. Sphincteric relaxation during swallowing was prolonged. Plasma gastrin levels were unchanged. Intravenous infusion of PGE2 (0-08 mug kg-minus1 min-minus) inhibited sphincter contractions to serial bolus intravenous injections of pentagastrin (0-1 or 0-2 mug kg-minus 1). Rectal indomethacin (200 mg) resulted in a riseof cardiac sphincter pressure, suggesting that endogenous synthesis of an inhibitory (E-type) prostaglandin was suppressed. The results indicate that prostaglandin E2 may be concerned in the regulation of cardiac sphincter tone in man, whilst prostaglandin F2alpha may be useful in the treatment of gastrooesphageal reflux.

Dilawari, J B; Newman, A; Poleo, J; Misiewicz, J J

1975-01-01

290

Determining the shape of the turns-amplitude cloud during anal sphincter quantitative EMG.  

PubMed

We aimed to compare our normative data for quantitative interference pattern (IP) analysis of the anal sphincter to previously published data. In 28 nulliparous women, we performed IP analysis during quantitative concentric needle electromyography (QEMG) of the anal sphincter. At each sampling site, a 500-ms epoch was analyzed. The data were log transformed. Linear regression lines (with 95% confidence intervals) were calculated from the log transformed variables "turns-second" and "amplitude-turn." These confidence intervals were then transformed back into the original parameters to yield scatterplots with confidence curves. The mean turns-second were 203 (SD 174). The mean amplitude (mcv)-turn was 266 (SD 87). The regression coefficients for the log-transformed variables are constant = 1.5, slope = 0.3, and resultant cloud of raw data has a convex upper boundary. These appear slightly different than previously published reports, potentially influencing the determination of normal and abnormal studies. PMID:18250946

Gregory, W Thomas; Clark, Amanda L; Simmons, Kimberly; Lou, Jau-Shin

2008-07-01

291

Clinical pharmacology and therapeutics of the oesophagus and the lower oesophageal sphincter  

PubMed Central

Oesophageal function can be studied with intraluminal manometry, indwelling pH electrodes or with in vitro methods using isolated tissue. Radiology and endoscopy are the main diagnostic procedures. Innervation of the body of the oesophagus is mainly cholinergic, but the lower oesophageal sphincter appears to be affected by a wide range of biogenic substances, such as autonomic transmitters, polypeptide hormones and prostaglandins. Most drugs used in the treatment of oesophageal disorders act by modifying the action of the naturally occurring agents.

Misiewicz, J. J.

1974-01-01

292

Lower esophageal sphincter relaxation characteristics using a sleeve sensor in clinical manometry  

Microsoft Academic Search

Objective:We undertook this study to determine the characteristics of swallow-induced lower esophageal sphincter (LES) relaxation in the setting of clinical manometry using a standardized methodology.Methods:We reviewed 170 manometric recordings performed using a perfused manometric assembly with a sleeve sensor and a computer polygraph. Patients were categorized as patient controls, gastroesophageal reflux disease (GERD), diffuse esophageal spasm (DES), or achalasia. Tracing

Guoxiang Shi; Gulchin A. Ergun; Michael Manka; Peter J. Kahrilas

1998-01-01

293

Functional Morphology of Anal Sphincter Complex Unveiled by High Definition Manometery & 3-Dimensional Ultrasound Imaging  

PubMed Central

Objective Anal sphincter complex consists of anatomically overlapping internal anal sphincter (IAS), external anal sphincter (EAS) & puborectalis muscle (PRM). We determined the functional morphology of anal sphincter muscles using high definition manometery (HDAM), 3D-ultrasound (US) and Magnetic resonance (MR) imaging. Patients We studied 15 nulliparous women. Interventions HDAM probe equipped with 256 pressure transducers was used to measure the anal canal pressures at rest and squeeze. Lengths of IAS, PRM and EAS were determined from the 3D-US images and superimposed on the HDAM plots. Movements of anorectal angle with squeeze were determined from the dynamic MR images. Results HDAM plots reveal that anal canal pressures are highly asymmetric in the axial and circumferential direction. Anal canal length determined by the 3D-US images is slightly smaller than measured by HDAM. The EAS (1.9 ± 0.5 cm long) and PRM (1.7 ± 0.4 cm long) surround distal and proximal parts of the anal canal respectively. With voluntary contraction, anal canal pressures increase in the proximal (PRM) and distal (EAS zone) parts of anal canal. Posterior peak pressure in the anal canal moves cranially in relationship to the anterior peak pressure, with squeeze. Similar to the movement of peak posterior pressure, MR images show cranial movement of anorectal angle with squeeze. Conclusion Our study proves that the PRM is responsible for the closure of the cranial part of anal canal. HDAM, in addition to measuring constrictor function can also record the elevator function of levator ani/pelvic floor muscles.

Raizada, Varuna; Bhargava, Valmik; Karsten, Anna; Mittal, Ravinder K.

2011-01-01

294

Prolonged anorectal manometry and external anal sphincter electromyography in ambulant human subjects  

Microsoft Academic Search

We have developed a method for prolonged combined anorectal manometry and electro-myography (EMG) of the external anal sphincter in ambulant subjects. Fourteen healthy volunteers were studied for a total of 284 hr (mean of 20.3 hr\\/subject). Anorectal manometry was performed using a probe with twin pressure sensors. EMG was recorded by one indifferent and two differential silver-silver chloride surface electrodes

D. Kumar; D. Waldron; N. S. Williams; C. Browning; M. R. E. Hutton; D. L. Wingate

1990-01-01

295

Colorectal and rectocolonic reflexes in canines: involvement of tone, compliance, and anal sphincter relaxation  

PubMed Central

Distention of the proximal colon may have inhibitory or excitatory effects on the rectum and vice versa. The reflexes between the proximal colon and the rectum have not been well studied due to difficulties in accessing the proximal colon. The aim of this study was to investigate the reflex responses and their mechanisms between the proximal colon and the rectum in consideration of distention-related changes in tone and compliance of these regions as well as anal sphincter relaxation in a canine model. Proximal colon/rectal tone, compliance, and anal sphincter relaxation were investigated in six dogs chronically implanted with a proximal colon cannula while in the fasting state and during proximal colon distention or rectal distention. It was found that: 1) both rectal distention and proximal colon distention significantly and substantially decreased the compliance of the opposite regions, and guanethidine abolished proximal colon distention-induced changes in rectal compliance; 2) rectal/proximal colon distension decreased proximal colonic/rectal tone, and guanethidine abolished both of these inhibitory effects; 3) the anal sphincter was more sensitive to rectal distention than proximal colon distention; and 4) the minimal distention pressure required to induce anal inhibitory reflex was lower for rectal distention than proximal colon distention. It was concluded that distention-related changes in tone and compliance suggest the long inhibitory reflexes between the proximal colon and the rectum with the sympathetic involvement in rectal responses. The anal sphincter is more sensitive to the distention of the rectum than that of the proximal colon.

Chen, Ji-Hong; Sallam, Hanaa S.; Lin, Lin

2010-01-01

296

Clinical significance of detrusor sphincter dyssynergia type in patients with post-traumatic spinal cord injury  

Microsoft Academic Search

Objectives. To investigate the significance of categorizing detrusor sphincter dyssynergia (DSD) by type in patients with chronic spinal cord injury.Methods. A retrospective review of the charts, video-urodynamic studies, and upper tract radiographic studies of 269 patients with post-traumatic, suprasacral spinal cord injuries was performed. The patients were categorized according to the DSD type (intermittent or continuous), level and completeness of

Kyle J Weld; Marshall J Graney; Roger R Dmochowski

2000-01-01

297

Sphincter-saving procedure for treatment of diffuse cavernous hemangioma of the rectum and sigmoid colon  

Microsoft Academic Search

Two cases of diffuse cavernous hemangioma of the rectum and rectosigmoid colon are reported. Sphincter-saving procedures were\\u000a applied as the surgical treatment for these two patients. The diseased rectum and distal sigmoid colon were resected 3 cm\\u000a above the pectinate line. The mucosa of the rectal stump was extirpated. All visible residue from the hemangiomatous tissues\\u000a on the muscular cuff,

Chen-Hwu Wang

1985-01-01

298

Incidence of obstetric anal sphincter injuries after training to protect the perineum: cohort study  

PubMed Central

Objective To compare the incidence of obstetric anal sphincter injuries (OASIS) in two time periods, before and after implementing a training programme for improved perineal support aimed at reducing the incidence of obstetric anal sphincter injuries. The secondary aim was to study incidence of obstetric anal sphincter injuries in subgroups defined by risk factors for OASIS. Design Population-based cohort study. Setting University hospital setting in Oslo, Norway. Participants Two cohorts of all delivering women in the largest hospital in Norway during two time periods (2003–2005 and 2008–2010) were studied. After excluding caesarean sections and preterm deliveries (< week 32), the study population consisted of 31?709 deliveries, among which 907 women were identified with obstetric anal sphincter injury. Primary and secondary outcome measures Incidence of OASIS in two time periods. Maternal, obstetrical and foetal risk factors for OASIS were collected from the hospital obstetric database. Univariate analyses and multivariate logistic regression analyses, presenting adjusted ODs for OASIS, were performed. Results The OASIS incidence was significantly reduced by 50%, from 4% (591/14787) in the first time period to 1.9% (316/16?922) in the second. This reduction could not be explained by changes in population characteristics or OASIS risk factors during the study years. The reduction of incidence of OASIS between the two study periods was consistent across subgroups of women; regardless of parity, delivery method and infant birth weight. Conclusions A marked reduction in the incidence of OASIS was observed in all studied subgroups of women after implementing the training programme for perineal protection. Further, this reduction could not be explained by the differences in patient characteristics across the study period. These findings indicate that the training programme with improved perineal protection markedly reduced the risk of OASIS.

Laine, Katariina; Skjeldestad, Finn Egil; Sandvik, Leiv; Staff, Anne Cathrine

2012-01-01

299

Long-term anal sphincter performance after surgery for Hirschsprung's disease  

Microsoft Academic Search

Background\\/Purpose: The aim of the study was to assess anal sphincter performance in relation to clinical fecal continence in adult patients who have Hirschsprung's disease.Methods: Fifty-four adult patients (mean age, 29 ± 7.2 years; 46 men; 8 women) who had undergone surgery for Hirschsprung's disease during their childhood underwent anorectal manometry and clinical examination. Fecal continence was evaluated with a

M Heikkinen; R Rintala; P Luukkonen

1997-01-01

300

Frequencies and cyclical pattern of the human sphincter of Oddi phasic activity  

Microsoft Academic Search

Basal frequency of sphincter of Oddi phasic contractility has been repeatedly measured during endoscopic manometry and reported to range, in control subjects, from (M +\\/- SE) 3.0 +\\/- 0.6 to 7.5 +\\/- 0.7 c\\/min. Recently, high frequency (greater than 8 c\\/min) phasic contractions or absence of phasic activity were recorded in patients with postcholecystectomy or pancreatic complaints, possibly suggesting a

A Torsoli; E Corazziari; F I Habib; E De Masi; D Biliotti; R Mazzarella; D Giubilei; G Fegiz

1986-01-01

301

Sexual Dysfunction and Infertility  

MedlinePLUS

... cause problems getting pregnant (infertility). But trying to get pregnant may also cause sexual dysfunction! A cause of infertility. If you are trying to get pregnant, you have to have sex at the right ...

302

Radial nerve dysfunction (image)  

MedlinePLUS

The radial nerve travels down the arm and supplies movement to the triceps muscle at the back of the upper arm. ... the wrist and hand. The usual causes of nerve dysfunction are direct trauma, prolonged pressure on the ...

303

Metal-sensitive and thermostable trypsin from the crevalle jack (Caranx hippos) pyloric caeca: purification and characterization  

PubMed Central

Background Over the past decades, the economic development and world population growth has led to increased for food demand. Increasing the fish production is considered one of the alternatives to meet the increased food demand, but the processing of fish leads to by-products such as skin, bones and viscera, a source of environmental contamination. Fish viscera have been reported as an important source of digestive proteases with interesting characteristics for biotechnological processes. Thus, the aim of this study was to purify and to characterize a trypsin from the processing by-products of crevalle jack (Caranx hippos) fish. Results A 27.5 kDa trypsin with N-terminal amino acid sequence IVGGFECTPHVFAYQ was easily purified from the pyloric caeca of the crevalle jack. Its physicochemical and kinetic properties were evaluated using N-?-benzoyl-DL-arginine-p-nitroanilide (BApNA) as substrate. In addition, the effects of various metal ions and specific protease inhibitors on trypsin activity were determined. Optimum pH and temperature were 8.0 and 50°C, respectively. After incubation at 50°C for 30 min the enzyme lost only 20% of its activity. K m , k cat, and k cat /K m values using BApNA as substrate were 0.689 mM, 6.9 s-1, and 10 s-1 mM-1, respectively. High inhibition of trypsin activity was observed after incubation with Cd2+, Al3+, Zn2+, Cu2+, Pb2+, and Hg2+ at 1 mM, revealing high sensitivity of the enzyme to metal ions. Conclusions Extraction of a thermostable trypsin from by-products of the fishery industry confirms the potential of these materials as an alternative source of these biomolecules. Furthermore, the results suggest that this trypsin-like enzyme presents interesting biotechnological properties for industrial applications.

2013-01-01

304

Sinus Node Dysfunction  

Microsoft Academic Search

Sinus node dysfunction was initially described in the early 1900s, and is the primary indication for pacemaker implantation\\u000a in industrialized countries. The only effective treatment for symptomatic sinus node dysfunction is cardiac pacing. However,\\u000a despite the widespread use of pacing therapy for this group of patients, the optimal pacing mode, pacing system and site of\\u000a ventricular stimulation for sinus node

Irene H. Stevenson; Paul B. Sparks; Jonathan M. Kalman

305

Sphincter-saving surgeries for rectal cancer: A single center study from Kashmir  

PubMed Central

Summary and Background Data: The goals in the treatment of rectal cancer are cure, local control, and preservation of sphincter, bladder and sexual function. Surgical resection using sharp mesorectal dissection is important for achieving these goals. Objectives: The current treatment of choice for carcinoma rectum is sphincter saving procedures, which have practically replaced the previously done abdominoperineal resection. We performed a study in our institute to evaluate the surgical outcome and complications of rectal cancer. Materials and Methods: This prospectivestudy included 117 patients, treated for primary rectal cancer by low anterior resection (LAR) from May 2007 to December 2010. All patients underwent standard total mesorectal excision (TME) followed by restoration of continuity. Results: The peri-operative mortality rate was 2.5% (3/117). Post-operative complications occurred in 32% of the patients. After a median follow up of 42 months, local recurrences developed in 6 (5%) patients and distant metastasis in 5 (4.2%). The survival rate was 93%. Conclusion: The concept of total mesorectal excision (TME), advances in stapling technology and neoadjuvant therapy have made it possible to preserve the anal sphincter in most of the patients. Rectal cancer needs to be managed especially in a specialized unit for better results.

Mir, Shabeer Ahmed; Chowdri, Nisar A.; Parray, Fazl Q.; Mir, Parvez Ahmed; Bashir, Yasir; Nafae, Muntakhab

2013-01-01

306

Sphincter-Preserving Therapy for Treating a Chronic Anal Fissure: Long-term Outcomes  

PubMed Central

Purpose To estimate the risk of recurrent fissure in ano after sphincter preserving treatments. Methods A retrospective case note review, combined with a telephone survey was conducted for all patients treated for a chronic anal fissure between 1998 and 2008. Results Six hundred and twelve patients (303 women: mean age, 39 years; range, 16-86 years) were treated for chronic anal fissure between 1998 and 2008. Topical diltiazem 2% was initially prescribed for 8 weeks. The fissure did not heal in 141 patients. These patients (61 women: mean age, 30 years; range, 15-86 years) were treated with 100 IU botulinum A toxin (Botox) injection combined with a fissurectomy under general anaesthesia. Thirty eight patients suffered a recurrence of their fissure within two years. Thirty-four healed with further medical or sphincter conserving surgical therapy while four required a lateral internal sphincterotomy. Conclusion The vast majority of patients with chronic anal fissure can be treated with sphincter conserving treatments. This may require several interventions before healing can be achieved. Assessment for recurrence after 'conservative' treatments requires a minimum of two-year follow-up.

Farouk, Ridzuan

2014-01-01

307

Assessment of experimental animal model for training obstetric anal sphincter injury techniques.  

PubMed

The Multiparous Goat Pelvic Model was used to train obstetricians and residents for perineal and anal sphincter anatomy and techniques of repair of Obstetric Anal Sphincter Injuries (OASIs). The purpose of this study was to assess the similarity of this model with human anatomy and the usefulness of goat model for training obstetricians for perineal tears. Six workshops were conducted between June 2009 and December 2010. A total of 90 participants, including 64(70.3%) residents and 26(28.5%) consultants in Obstetrics and Gynaecology, attended hands-on training workshops using experimental goat pelvic model for the repair of perineal tears. Among the consultants, 23 (88.5%), and 60 (93.7%) residents could easily identify the goat anal sphincter. With reference to the similarity to human vaginal dimensions, 20 (76.9%) consultants and 43(67.1%) residents found it to be similar with human anatomy. Evaluating the anal canal anatomy, 22 (84.6%) consultants and 34(53.1%) residents reported it to be similar to the human anal canal. The perineal body anatomy was reported as very different by both consultants and residents (80% and 67.9% respectively). All the consultants and 49(76.5%) of the residents strongly recommended the use of this model for future hands-on workshops. PMID:23865143

Rizvi, Raheela Mohsin

2013-01-01

308

Effect of glyceryl trinitrate on the sphincter of Oddi motility and baseline pressure.  

PubMed Central

It is widely accepted that glyceryl trinitrate (GTN) effectively dilates the smooth muscles of blood vessels. A similar effect has been postulated on the smooth muscles in the gastrointestinal tract. In this study the motility of the sphincter of Oddi and the common bile duct pressure as determined by endoscopic manometry was investigated in nine patients before and after sublingual application of 1.2 mg GTN (nitro group). Eight untreated patients served as controls. Three minutes after application of GTN the papillary contraction amplitude decreased from 69.3 +/- 4.3 mmHg to 36.8 +/- 5.1 mmHg (p less than 0.005) and the papillary baseline pressure fell from 8.9 +/- 0.6 mmHg to 2.9 +/- 0.2 mmHg (p less than 0.005) respectively. The contraction frequency in the nitro group and all motility parameters in the control group remained unchanged. These results indicate that GTN does not influence the sphincter of Oddi motility, but it relaxes very effectively the sphincter of Oddi muscle. Thus, GTN should be taken into account for the treatment of biliary colic. In our endoscopic unit GTN proved to be useful as premedication for endoscopic examinations, particularly for the removal of small and medium size common bile duct stones through the intact papilla.

Staritz, M; Poralla, T; Ewe, K; Meyer zum Buschenfelde, K H

1985-01-01

309

Characterization of basal hepatic bile flow and the effects of intravenous cholecystokinin on the liver, sphincter, and gallbladder in patients with sphincter of Oddi spasm.  

PubMed

The major objectives of this project were to establish the pattern of basal hepatic bile flow and the effects of intravenous administration of cholecystokinin on the liver, sphincter of Oddi, and gallbladder, and to identify reliable parameters for the diagnosis of sphincter of Oddi spasm (SOS). Eight women with clinically suspected sphincter of Oddi spasm (SOS group), ten control subjects (control group), and ten patients who had recently received an opioid (opioid group) were selected for quantitative cholescintigraphy with cholecystokinin. Each patient was studied with 111-185 MBq (3-5 mCi) technetium-99m mebrofenin after 6-8 h of fasting. Hepatic phase images were obtained for 60 min, followed by gallbladder phase images for 30 min. During the gallbladder phase, 10 ng/kg octapeptide of cholecystokinin (CCK-8) was infused over 3 min through an infusion pump. Hepatic extraction fraction, excretion half-time, basal hepatic bile flow into the gallbladder, gallbladder ejection fraction, and post-CCK-8 paradoxical filling (>30% of basal counts) were identified. Seven of the patients with SOS were treated with antispasmodics (calcium channel blockers), and one underwent endoscopic sphincterotomy. Mean (+/-SD) hepatic bile entry into the gallbladder (versus GI tract) was widely variable: it was lower in SOS patients (32%+/-31%) than in controls (61%+/-36%) and the opioid group (61%+/-25%), but the difference was not statistically significant. Hepatic extraction fraction, excretion half-time, and pattern of bile flow through both intrahepatic and extrahepatic ducts were normal in all three groups. Gallbladder mean ejection fraction was 9%+/-4% in the opioid group; this was significantly lower (P<0.0001) than the values in the control group (54%+/-18%) and the SOS group (48%+/-29%). Almost all of the bile emptied from the gallbladder refluxed into intrahepatic ducts; it reentered the gallbladder after cessation of CCK-8 infusion (paradoxical gallbladder filling) in all eight patients with SOS, but in none of the patients in the other two groups. Mean paradoxical filling was 204% (+/-193%) in the SOS group and less than 5% (P<0.05) in both the control and the opioid group. After treatment, six of the SOS patients had complete pain relief and one, partial pain relief. The basal tonus of the sphincter is variable in patients with SOS, and allows relatively more of the hepatic bile to enter the GI tract than the gallbladder. Due to simultaneous contraction of the sphincter and gallbladder in response to CCK-8, most of the bile emptied from the gallbladder refluxes into intrahepatic ducts, and reenters the gallbladder immediately after cessation of hormone infusion. The characteristic features of gallbladder filling, emptying, and paradoxical refilling with cholecystokinin provide objective parameters for noninvasive diagnosis of SOS by quantitative cholescintigraphy. PMID:14574515

Krishnamurthy, Gerbail T; Krishnamurthy, Shakuntala; Watson, Randy D

2004-01-01

310

The cone dysfunction syndromes  

PubMed Central

The cone dystrophies comprise a heterogeneous group of disorders characterised by visual loss, abnormalities of colour vision, central scotomata, and a variable degree of nystagmus and photophobia. They may be stationary or progressive. The stationary cone dystrophies are better described as cone dysfunction syndromes since a dystrophy often describes a progressive process. These different syndromes encompass a wide range of clinical and psychophysical findings. The aim is to review current knowledge relating to the cone dysfunction syndromes, with discussion of the various phenotypes, the currently mapped genes, and genotype-phenotype relations. The cone dysfunction syndromes that will be discussed are complete and incomplete achromatopsia, oligocone trichromacy, cone monochromatism, blue cone monochromatism, and Bornholm eye disease. Disorders with a progressive cone dystrophy phenotype will not be discussed.

Michaelides, M; Hunt, D M; Moore, A T

2004-01-01

311

Immune dysfunction in cirrhosis.  

PubMed

Innate and adaptive immune dysfunction, also referred to as cirrhosis-associated immune dysfunction syndrome, is a major component of cirrhosis, and plays a pivotal role in the pathogenesis of both the acute and chronic worsening of liver function. During the evolution of the disease, acute decompensation events associated with organ failure(s), so-called acute-on chronic liver failure, and chronic decompensation with progression of liver fibrosis and also development of disease specific complications, comprise distinct clinical entities with different immunopathology mechanisms. Enhanced bacterial translocation associated with systemic endotoxemia and increased occurrence of systemic bacterial infections have substantial impacts on both clinical situations. Acute and chronic exposure to bacteria and/or their products, however, can result in variable clinical consequences. The immune status of patients is not constant during the illness; consequently, alterations of the balance between pro- and anti-inflammatory processes result in very different dynamic courses. In this review we give a detailed overview of acquired immune dysfunction and its consequences for cirrhosis. We demonstrate the substantial influence of inherited innate immune dysfunction on acute and chronic inflammatory processes in cirrhosis caused by the pre-existing acquired immune dysfunction with limited compensatory mechanisms. Moreover, we highlight the current facts and future perspectives of how the assessment of immune dysfunction can assist clinicians in everyday practical decision-making when establishing treatment and care strategies for the patients with end-stage liver disease. Early and efficient recognition of inappropriate performance of the immune system is essential for overcoming complications, delaying progression and reducing mortality. PMID:24627592

Sipeki, Nora; Antal-Szalmas, Peter; Lakatos, Peter L; Papp, Maria

2014-03-14

312

Management of obstetric anal sphincter injury: a systematic review & national practice survey  

PubMed Central

Background We aim to establish the evidence base for the recognition and management of obstetric anal sphincter injury (OASI) and to compare this with current practice amongst UK obstetricians and coloproctologists. Methods A systematic review of the literature and a postal questionnaire survey of consultant obstetricians, trainee obstetricians and consultant coloproctologists was carried out. Results We found a wide variation in experience of repairing acute anal sphincter injury. The group with largest experience were consultant obstetricians (46.5% undertaking ? 5 repairs/year), whilst only 10% of responding colorectal surgeons had similar levels of experience (p < 0.001). There was extensive misunderstanding in terms of the definition of obstetric anal sphincter injuries. Overall, trainees had a greater knowledge of the correct classification (p < 0.01). Observational studies suggest that a new 'overlap' repair using PDS sutures with antibiotic cover gives better functional results. However, our literature search found only one randomised controlled trial (RCT) on the technique of repair of OASI, which showed no difference in incidence of anal incontinence at three months. Despite this, there was a wide variation in practice, with 337(50%) consultants, 82 (55%) trainees and 80 (89%) coloproctologists already using the 'overlap' method for repair of a torn EAS (p < 0.001). Although over 50% of colorectal surgeons would undertake long-term follow-up of their patients, this was the practice of less than 10% of obstetricians (p < 0.001). Whilst over 70% of coloproctologists would recommend an elective caesarean section in a subsequent pregnancy, only 22% of obstetric consultants and 14% of trainees (p < 0.001). Conclusion An agreed classification of OASI, development of national guidelines, formalised training, multidisciplinary management and further definitive research is strongly recommended.

Fernando, Ruwan J; Sultan, Abdul H; Radley, Simon; Jones, Peter W; Johanson, Richard B

2002-01-01

313

Is there a nitrergic modulation of the rat external anal sphincter?  

PubMed

Nitric oxide is known to relax the internal anal sphincter, but its effect on the external anal sphincter (EAS) is unknown. The aim of this study was to investigate whether there is a nitrergic nerve plexus that modulates the EAS, similar to that found in oesophageal striated muscle. An in vitro ring preparation of rat anal canal was used to evaluate the effects of the nitric oxide synthase inhibitor N(?)-nitro-L-arginine (L-NNA) and the NO donor sodium nitroprusside (SNP) on the EAS in conditions of neuromuscular blockade and the effect of SNP on nerve-evoked contractions. Immunohistological experiments were conducted to determine whether the neuronal isoform of nitric oxide synthase (nNOS) is present in the EAS. During direct muscle stimulation neither L-NNA (P = 0.32) nor SNP (P = 0.19) significantly changed the EF(50), which is the frequency at which 50% of maximal contraction is reached, compared with a time-dependent control. Nerve-evoked contractions were also not altered by addition of SNP to the tissue bath. Immunohistohistological experiments clearly showed co-localization of nNOS-positive nerve fibres at motor endplates of the oesophagus but not in the EAS. The internal anal sphincter was richly innervated by nitrergic fibres, but these did not extend into the EAS. In conclusion, there are no nitrergic motor fibres innervating the EAS, neurotransmission at the motor endplates is not affected by NO, and NO does not affect muscle force directly in conditions of neuromuscular blockade. There is, therefore, no evidence that EAS contraction is directly modulated by NO or by pudendal nitrergic fibres or diffusion from neighbouring nitrergic plexuses of the anal canal. PMID:22872659

Evers, J; Buffini, M; Craven, S; O'Connell, P R; Jones, J F X

2013-02-01

314

Internal Anal Sphincter Function Following Lateral Internal Sphincterotomy for Anal Fissure  

PubMed Central

Background: Anal fissure is a common and painful disorder. Its relation to hypertonic anal sphincter is controversial. The most common surgical treatment of chronic anal fissure is lateral internal sphincterotomy. Objective: The aim of this study was to evaluate long-term manometric results of sphincter healing following lateral internal sphincterotomy. Patients and Methods: Between 2000 and 2003, 50 patients with anal fissure were included in this study and underwent sphincterotomy; 12 healthy patients served as controls. All patients with anal fissure underwent manometric evaluation using a 6-channel perfusion catheter. All patients were examined 1 month before surgery and 1, 3, 6, and 12 months following surgery. The control group had 3 manometric evaluations 6 months apart. Results: The mean basal resting pressure before surgery was 138 ± 28 mm Hg. One month after surgery, the pressure dropped to 86 ± 15 mm Hg (P < 0.0001) and gradually rose to a plateau at 12 months (110 ± 18 mm Hg, P < 0.0001). At 12 months, the manometric pressure was significantly lower than the baseline (P < 0.0001). However, manometric measurements in the fissure group were still significantly higher than in the control group (110 ± 18 versus 73 ± 4.8 mm Hg, P < 0.0001). All patients were free of symptoms at the 12-month follow-up. Conclusion: Lateral internal sphincterotomy caused a significant decline in the resting anal pressure. During the first year following surgery, the tone of the internal anal sphincter gradually increased, indicating recovery, but still remained significantly lower than before surgery. However, postoperative resting pressures were higher than those in the control, and no patient suffered any permanent problems with incontinence, so this decrease may not be clinically significant.

Ram, Edward; Alper, Dan; Stein, Gideon Y.; Bramnik, Zachar; Dreznik, Zeev

2005-01-01

315

Epidemiology of Erectile Dysfunction  

Microsoft Academic Search

Erectile dysfunction (ED) is a pervasive problem among men worldwide. The National Institutes of Health Consensus Conference\\u000a defined ED as the “consistent inability to attain or maintain a penile erection, or both, sufficient for adequate sexual relations”\\u000a (1).

Jonathan D. Schiff; John P. Mulhall

316

Mitochondrial Dysfunction in Cancer  

PubMed Central

A mechanistic understanding of how mitochondrial dysfunction contributes to cell growth and tumorigenesis is emerging beyond Warburg as an area of research that is under-explored in terms of its significance for clinical management of cancer. Work discussed in this review focuses less on the Warburg effect and more on mitochondria and how dysfunctional mitochondria modulate cell cycle, gene expression, metabolism, cell viability, and other established aspects of cell growth and stress responses. There is increasing evidence that key oncogenes and tumor suppressors modulate mitochondrial dynamics through important signaling pathways and that mitochondrial mass and function vary between tumors and individuals but the significance of these events for cancer are not fully appreciated. We explore the interplay between key molecules involved in mitochondrial fission and fusion and in apoptosis, as well as in mitophagy, biogenesis, and spatial dynamics of mitochondria and consider how these distinct mechanisms are coordinated in response to physiological stresses such as hypoxia and nutrient deprivation. Importantly, we examine how deregulation of these processes in cancer has knock on effects for cell proliferation and growth. We define major forms of mitochondrial dysfunction and address the extent to which the functional consequences of such dysfunction can be determined and exploited for cancer diagnosis and treatment.

Boland, Michelle L.; Chourasia, Aparajita H.; Macleod, Kay F.

2013-01-01

317

Predicting lower urinary tract dysfunctions in patients with spinal cord injury.  

PubMed

The results of combined cystometry and perineal electromyography were reviewed retrospectively in 75 consecutive, traumatic spinal cord-injured patients to predict lower urinary tract dysfunctions. In patients with vertebral spinal injuries at vertebral level T7 or above a reflex neurogenic bladder eventually developed. In those with vertebral level injuries T11 or below a lower motor neuron bladder dysfunction developed. Injuries at the vertebral levels T8, T9, and T10 represent a gray zone; and, depending on adjacent soft tissue injury, in these patients an upper or lower motor neuron bladder dysfunction developed. In transition from spinal shock (areflexia) to reflex neurogenic (hyperreflexia) bladder occurred at different times in different patients and could not be correlated to level of injury or its severity. The periurethral striated muscle was generally denervated if a lower motor neuron bladder dysfunction existed, however, rarely, dissociation may occur. When a reflex neurogenic bladder existed, sphincter dyssynergia was present 68 per cent of the time. This also could not be correlated with time after injury, level of injury, or severity of injury. PMID:7198327

Perlow, D L; Diokno, A C

1981-11-01

318

Paradoxical response of sphincter of Oddi to intravenous injection of cholecystokinin or ceruletide. Manometric findings and results of treatment in biliary dyskinesia  

Microsoft Academic Search

Sixty two patients with a clinical suspicion of biliary dyskinesia were investigated with endoscopic manometry of the sphincter of Oddi before and after intravenous injection of cholecystokinin or ceruletide. In 52 patients injection was followed by decreased pressure in the sphincter of Oddi; 43 of these had normal prestimulatory values (group I), while the values were raised in the other

P Rolny; A Arlebäck; P Funch-Jensen; A Kruse; J Ravnsbaeck; G Järnerot

1986-01-01

319

Effects of botulinum toxin A on the sphincter of Oddi: an in vivo and in vitro study  

PubMed Central

Background—Botulinum toxin A is a potent inhibitor of the release of acetylcholine from nerve endings. Local injection of botulinum toxin has recently been suggested to be helpful in sphincter of Oddi dyskinesia by decreasing sphincter of Oddi pressure. ?Aims—To explore the mechanism of action of botulinum toxin A on sphincter of Oddi (SO) muscle. ?Methods—Four piglets underwent duodenoscopy and SO manometry was performed. After obtaining a baseline pressure, the SO was injected with normal saline and the experiment repeated after one week. The SO was then injected endoscopically with botulinum toxin (40 U) with follow up manometry one week later. The sphincter of Oddi was removed from 10 pigs, cut into three rings, and placed in an organ bath. The force of contraction was measured and registered on a polygraph. Rings were stimulated by 70 V (10 Hz, 0.5 ms) electrical field stimulation for 20 seconds, exogenous acetylcholine (100 µM), and KCl (125 mM). Botulinum toxin (0.1 U/ml) or atropine (1 µM) was added to the incubation medium and the stimulation was repeated. ?Results—Mean basal SO pressure in the pigs remained unchanged after saline injection but decreased to about 50% of baseline value following botulinum toxin injection (p=0.04). The contractions induced by direct stimulation of SO smooth muscle with KCl were not significantly affected by either atropine or botulinum toxin. In all rings exogenous acetylcholine induced contractions, which were totally blocked by atropine, but not by botulinum toxin. Electrical field stimulation induced contractions that were inhibited by both atropine and botulinum toxin. ?Conclusion—Botulinum toxin inhibits pig sphincter of Oddi smooth muscle contractions by a presynaptic cholinergic mechanism, similar to that described in skeletal muscle. ?? Keywords: sphincter of Oddi; botulinum toxin; pig; ex vivo

Sand, J; Nordback, I; Arvola, P; Porsti, I; Kalloo, A; Pasricha, P

1998-01-01

320

Mean Absorbed Dose to the Anal-Sphincter Region and Fecal Leakage among Irradiated Prostate Cancer Survivors  

SciTech Connect

Purpose: To supplement previous findings that the absorbed dose of ionizing radiation to the anal sphincter or lower rectum affects the occurrence of fecal leakage among irradiated prostate-cancer survivors. We also wanted to determine whether anatomically defining the anal-sphincter region as the organ at risk could increase the degree of evidence underlying clinical guidelines for restriction doses to eliminate this excess risk. Methods and Materials: We identified 985 men irradiated for prostate cancer between 1993 and 2006. In 2008, we assessed long-term gastrointestinal symptoms among these men using a study-specific questionnaire. We restrict the analysis to the 414 men who had been treated with external beam radiation therapy only (no brachytherapy) to a total dose of 70 Gy in 2-Gy daily fractions to the prostate or postoperative prostatic region. On reconstructed original radiation therapy dose plans, we delineated the anal-sphincter region as an organ at risk. Results: We found that the prevalence of long-term fecal leakage at least once per month was strongly correlated with the mean dose to the anal-sphincter region. Examining different dose intervals, we found a large increase at 40 Gy; {>=}40 Gy compared with <40 Gy gave a prevalence ratio of 3.8 (95% confidence interval 1.6-8.6). Conclusions: This long-term study shows that mean absorbed dose to the anal-sphincter region is associated with the occurrence of long-term fecal leakage among irradiated prostate-cancer survivors; delineating the anal-sphincter region separately from the rectum and applying a restriction of a mean dose <40 Gy will, according to our data, reduce the risk considerably.

Alsadius, David, E-mail: david.alsadius@oncology.gu.se [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden)] [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden); Hedelin, Maria [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden) [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden); Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm (Sweden); Lundstedt, Dan [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden)] [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden); Pettersson, Niclas [Department of Radiophysics, Sahlgrenska Academy at University of Gothenburg (Sweden)] [Department of Radiophysics, Sahlgrenska Academy at University of Gothenburg (Sweden); Wilderaeng, Ulrica [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden)] [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden); Steineck, Gunnar [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden) [Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg (Sweden); Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm (Sweden)

2012-10-01

321

The Treatment of Erectile Dysfunction  

Microsoft Academic Search

Erectile dysfunction (ED) is a common age-related sexual dysfunction. It can be a treatment challenge for the therapist because it is notoriously associated with psychological, physical and relational risk factors. Typically, ED adversely impacts the man's self esteem, partner satisfaction and the couple's intimate relationship. This sexual dysfunction is often co-morbid with physical risk factors such as diabetes and cardiovascular

Nancy Gambescia; Shelley Kara Sendak

2009-01-01

322

Opioid-Induced Gastrointestinal Dysfunction  

Microsoft Academic Search

Use of opioid analgesics is associated with a number of side effects, especially opioid-induced gastrointestinal dysfunction. The extensive use of these compounds and the significant negative impact of the resulting gastrointestinal dysfunction on patients’ quality of life make it an important clinical issue. In recent years our understanding of the mechanisms of opioid-induced gastrointestinal dysfunction has advanced greatly. This article

Sangeeta R. Mehendale; Chun-Su Yuan

2006-01-01

323

Lack of effect of a 5-HT3 antagonist, pancopride, on lower oesophageal sphincter pressure in volunteers.  

PubMed Central

Effects of pancopride (5 and 10 mg, intravenously), on lower oesophageal sphincter pressure (LOESP), were assessed in healthy volunteers by means of oesophageal manometry. After pancopride 10 mg, the LOESP was higher than placebo and 5 mg pancopride but there were no differences among the three treatments (P = 0.42). The areas under the curve were similar without differences, neither with absolute measurements (P = 0.53) nor after a baseline correction (P = 0.16). In conclusion, pancopride has no clinically relevant effect on lower oesophageal sphincter pressure.

Grande, L; Lacima, G; Perez, A; Zayas, J M

1995-01-01

324

Post-pyloric feeding  

PubMed Central

Postpyloric feeding is an important and promising alternative to parenteral nutrition. The indications for this kind of feeding are increasing and include a variety of clinical conditions, such as gastroparesis, acute pancreatitis, gastric outlet stenosis, hyperemesis (including gravida), recurrent aspiration, tracheoesophageal fistula and stenosis in gastroenterostomy. This review discusses the differences between pre- and postpyloric feeding, indications and contraindications, advantages and disadvantages, and provides an overview of the techniques of placement of various postpyloric devices.

Niv, Eva; Fireman, Zvi; Vaisman, Nachum

2009-01-01

325

Primary anorectal malignant melanoma treated with neoadjuvant chemoradiotherapy and sphincter-sparing surgery: A case report  

PubMed Central

Primary anorectal (PA) malignant melanoma (MM) is a rare disease associated with a high mortality rate. The most appropriate treatment strategy for PAMM remains controversial. A 55-year-old female patient, who was misdiagnosed with locally advanced rectal carcinoma, was treated with preoperative radiotherapy and concurrent oral capecitabine. During the therapy, grade 1 leukopenia occurred, however, there was no interruption to treatment. Following chemoradiotherapy, a computer tomography scan identified that the tumor had shrunk significantly and the original enlarged lymph nodes had disappeared. Eight weeks after completion of chemoradiotherapy, sphincter-sparing surgery was performed on the patient and based on the postoperative pathological result, MM was diagnosed. At the time of writing, the patient has survived disease-free for 15 months and at the most recent follow-up examination the Karnofsky Performance Scale score was 100. The therapeutic regimen of neoadjuvant concurrent chemoradiotherapy together with sphincter-sparing surgery is considered to be an optimal choice for patients with PAMM. However, further studies are required to evaluate the efficacy and clinical utility of this therapeutic regimen.

SU, MENG; ZHU, LUCHENG; LUO, WENHUA; WEI, HANGPING; ZOU, CHANGLIN

2014-01-01

326

Duloxetine for treatment of male sphincteric incontinence following partial conus medullaris infarction after coronary bypass surgery  

PubMed Central

Introduction Vascular spinal cord injury following coronary bypass grafting surgery is very rare and this is probably one of few reports of a presumptive partial conus medullaris lesion leading to sudden onset bladder and bowel incontinence which was managed using duloxetine, a selective serotonin and norepinephrine reuptake inhibitor. Duloxetine has been used in selected patients with post-prostatectomy sphincteric incontinence but not, to our knowledge, for spinal vascular lesions. Case presentation A 63-year-old Indian man developed bladder and bowel incontinence immediately following coronary bypass grafting surgery. Findings were suggestive of microcirculatory partial conus medullaris infarction. Based on his urodynamics findings he was managed with duloxetine, tolterodine and clean intermittent catheterization. The clinical presentation, serial urodynamic findings and implications are discussed. Conclusion Spinal injury following coronary bypass grafting is rare and devastating. It is important to be able to recognize the problem even when paraplegia is not noted, counsel the patient and manage the patient with the help of urodynamics. In patients with sphincteric incontinence, duloxetine may have a role in management.

2009-01-01

327

Variability of lower esophageal sphincter pressure in the fasted unanesthetized opossum.  

PubMed

The opossum has served as a useful animal model for in vivo studies of lower esophageal sphincter (LES) function. Previous investigations, however, have been confined to studies on anesthetized animals. In 10 opossums we investigated LES pressure during fasting cycles of the gastrointestinal migrating myoelectric complex (MMC) and examined the influences of anesthesia and feeding on LES pressure. Intraluminal pressure from the esophageal body, LES, and gastric antrum was recorded by a manometric assembly that incorporated a sleeve device. Myoelectric activity was recorded from the gastric antrum and duodenum via implanted electrodes. MMCs were readily recorded from all animals. MMC cycle length was 86 +/- 2.9 (SE) min. The LES exhibited cyclic changes in intraluminal pressure that occurred in synchrony with the gastric MMC cycle. During phase I of the gastric MMC cycle, LES pressure was essentially stable, although intermittent spontaneous oscillations at 3-4/min were sometimes noted. Forceful phasic LES contraction started during phase II of the gastric MMC, became maximal during phase III, and disappeared during phase I. The MMC-related phasic LES contraction occurred at a maximal rate of 1.4 +/- 0.05/min with amplitudes of 60-150 mmHg and were temporally associated with spike bursts and contractions in the gastric antrum. Pentobarbital sodium-induced anesthesia abolished MMC-related phasic LES activity and caused a transient rise in basal sphincter pressure. Phasic LES activity was also inhibited by atropine and feeding.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3985147

Holloway, R H; Blank, E; Takahashi, I; Dodds, W J; Hogan, W J; Dent, J

1985-04-01

328

Long-term result of Memokath urethral sphincter stent in spinal cord injury patients  

PubMed Central

Background Memokath urethral sphincter stents are used to facilitate bladder emptying in patients with spinal cord injury, but long term follow-up has not been reported. Methods Case series of ten men with spinal cord injury who underwent insertion of Memokath stents and were followed for up to nine years. Results Within four years, the stent had to be removed in nine out of ten patients because of: extensive mucosal proliferation causing obstruction to the lumen of the stent; stone around the proximal end of the stent, incomplete bladder emptying, and recurrent urinary infections; migration of the stent into the bladder related to digital evacuation of bowels; large residual urine; concretions within the stent causing obstruction to flow of urine, and partial blockage of the stent causing frequent episodes of autonomic dysreflexia. In one patient the stent continued to function satisfactorily after nine years. Conclusions The Memokath stent has a role as a temporary measure for treatment of detrusor-sphincter dyssynergia in selected SCI patients who do not get recurrent urinary infection and do not require manual evacuation of bowels.

Vaidyanathan, Subramanian; Soni, Bakul M; Oo, Tun; Sett, Pradipkumar; Hughes, Peter L; Singh, Gurpreet

2002-01-01

329

Effect of the diaphragmatic contraction on lower oesophageal sphincter pressure in man.  

PubMed Central

The effect of diaphragmatic contraction and relaxation on the lower oesophageal sphincter (LOS) pressure was studied in 10 healthy volunteers. Pressures in the oesophagus, LOS, and stomach were measured in three phases. Phase I, end tidal expiration; phase II, subjects inspired to total lung capacity (TLC) and kept the airway open (sustained diaphragmatic contraction); and phase III, at TLC subjects relaxed against a closed glottis (diaphragm relaxed). The LOS pressure in phase II was significantly higher than in phase I, while in phase III it was significantly lower compared with phase I. There was a net increase in LOS pressure of 32 mmHg in phase II as compared to phase I. After phase II, as subjects moved into phase III, there was a sudden drop in the LOS pressure. The LOS pressure in phase II correlated with the transdiaphragmatic pressure in a linear fashion. These observations suggest that diaphragmatic contraction in man enhances the LOS pressure and this augmentation of sphincter tone may be a vital component of the antireflux mechanism.

Mittal, R K; Rochester, D F; McCallum, R W

1987-01-01

330

Electrical and mechanical activity in the human lower esophageal sphincter during diaphragmatic contraction.  

PubMed Central

To determine the effect of contraction of the diaphragm on the lower esophageal sphincter (LES) pressure, we studied eight healthy volunteers during spontaneous breathing, maximal inspiration, and graded inspiratory efforts against a closed airway (Muller's maneuver). Electrical activity of the crural diaphragm (DEMG) was recorded from bipolar esophageal electrodes, transdiaphragmatic pressure (Pdi) was calculated as the difference between gastric and esophageal pressures, and LES pressure was recorded using a sleeve device. During spontaneous breathing, phasic inspiratory DEMG was accompanied by phasic increases in Pdi and LES pressure. With maximal inspiration, DEMG increased 15-20-fold compared with spontaneous inspiration, and LES pressure rose from an end-expiratory pressure of 21 to 90 mmHg. Similar values were obtained during maximal Muller's maneuvers. LES pressure fell promptly when the diaphragm relaxed. Graded Muller's maneuver resulted in proportional increases in the Pdi, LES pressure, and DEMG. The LES pressure was always greater than Pdi and correlated with it in a linear fashion (P less than 0.001). We conclude that the contraction of the diaphragm exerts a sphincteric action at the LES, and that this effect is an important component of the antireflux barrier.

Mittal, R K; Rochester, D F; McCallum, R W

1988-01-01

331

Obstetric anal sphincter injuries: a survey of clinical practice among canadian obstetricians.  

PubMed

Objective: To describe the current practice, experience, and confidence of Canadian obstetricians in the management of obstetric anal sphincter injuries (OASIS) and to explore the need for national practice guidelines on this topic. Methods: We conducted a cross-sectional, Internet-based survey between December 2010 and March 2011. The survey was initially tested among a sample population and then distributed electronically to 665 Canadian obstetricians. Data were analyzed descriptively. The main outcome measures were the self-reported confidence and experience of Canadian obstetricians in OASIS management and the frequency of performing specific OASIS management steps. Results: The survey response rate was 28.7%. The majority of the respondents (95%) reported confidence in performing OASIS repairs. In the event of a perineal laceration, 47.9% of respondents routinely performed a rectal examination. Most OASIS repairs were performed in the delivery room (89.4%) under local anaesthesia (60.6%) when regional anaesthesia was not already present. If lacerated, the internal anal sphincter was repaired separately by 63.4% of respondents, and intraoperative antibiotics were ordered by 51.1% of respondents. Most (92%) reported the absence of a local protocol to guide OASIS repair. Conclusion: The confidence of Canadian obstetricians who participated in this survey in performing OASIS repairs was high. However, their experience in performing repairs and their use of management steps varied. The need for national guidelines and an increase in awareness is suggested. PMID:22947406

Best, Carolyn; Drutz, Harold P; Alarab, May

2012-08-01

332

Canine ileocolonic sphincter: flow, transit, and motility before and after sphincterotomy.  

PubMed

Our hypothesis was that the canine ileocolonic sphincter (ICS), per se, would have little regulatory effect on the transit of chyme from ileum to colon. We argued, from earlier observations, that the ileocolonic junction was influenced more by functional motor integration of the ileum, ICS, and proximal colon. In five dogs, the ileocolonic sphincter was ablated by extramucosal sphincterotomy; the operation significantly lowered tonic pressures at the ICS. Animals were then studied in the fasting state and postprandially. Ileal flow was estimated by marker dilution, and ileocolonic flow was estimated by total recovery of chyme from a colonic cannula. Transit times were measured after the bolus infusion of nonabsorbable markers. Ileocolonic sphincterotomy did not significantly alter flow rates or transit times of chyme across the ICS, although ileal motor patterns were changed after sphincterotomy. We concluded that the ICS probably has only a small effect on transit and flow at the ileocolonic junction. These findings argue for the importance of integrated motility of the ileum, ICS, and proximal colon in controlling the flow of chyme in this region. PMID:1996647

Neri, M; Phillips, S F; Fich, A; Haddad, A C

1991-02-01

333

The distribution and chemical coding of neurons supplying the sphincter of Oddi in mammals.  

PubMed

The major duodenal papilla (papilla of Vater) is an important structure associated with the biliary tract and, in some species, the pancreas. It usually represents a slight elevation on the intestinal mucosa where the dilated junction (ampulla of Vater) of the commmon bile duct and pancreatic duct enters the duodenum. The ampulla is surrounded by a specifically arranged muscle structure called the sphincter of Oddi (SO) which controls the flow of bile and pancreatic fluid. The function of the sphincter is regulated by a complex system that involves many hormonal and neural factors. The literature in the field contains detailed data on the morphology of the SO in a number of mammalian species. However, the comprehensive information about the anatomy and neurochemistry of the innervation of this structure is very limited. The present review article summarizes the current knowledge on the innervation of the SO in mammals. Special emphasis has been put on the localization and chemical coding of neurons contributing to this nerve supply. PMID:24597319

Tomaszewska, O; Kaleczyc, J

2013-01-01

334

Automatic localisation of innervation zones: a simulation study of the external anal sphincter.  

PubMed

Traumas of the innervation zone (IZ) of the external anal sphincter (EAS), e.g. during delivery, can promote the development of faecal incontinence. Recently developed probes allow high-resolution detection of EMG signals from the EAS. The analysis of pelvic floor muscles by surface EMG (in particular, the estimation of the location of the IZ) has potential applications in the diagnosis and investigation of the mechanisms of incontinence. An automatic method (based on matched filter approach) for the estimation of the IZ distribution of EAS from surface EMG is discussed and tested using an analytical model of generation of EMG signals from sphincter muscles. Simulations are performed varying length of the fibres, thickness of the mucosa, position of the motor units, and force level. Different distributions of IZs are simulated. The performance of the proposed method in the estimation of the IZ distribution is affected by surface MUAP amplitude (as the estimation made by visual inspection), by mucosa thickness (performance decreases when fibre length is higher) and by different MU distributions. However, in general the method is able to identify the position of two IZ locations and can measure asymmetry of the IZ distribution. This strengthens the potential applications of high density surface EMG in the prevention and investigation of incontinence. PMID:19269857

Mesin, Luca; Gazzoni, Marco; Merletti, Roberto

2009-12-01

335

Prevalence of Sexual Dysfunctions  

PubMed Central

Ten years of research that has provided data regarding the prevalence of sexual dysfunctions is reviewed. A thorough review of the literature identified 52 studies that have been published in the 10 years since an earlier review by Spector and Carey (1990). Community samples indicate a current prevalence of 0 - 3% for male orgasmic disorder, 0 - 5% for erectile disorder, and 0 - 3% for male hypoactive sexual desire disorder. Pooling current and 1-year figures provides community prevalence estimates of 7 - 10% for female orgasmic disorder and 4 - 5% for premature ejaculation. Stable community estimates of the current prevalence for the other sexual dysfunctions remain unavailable. Prevalence estimates obtained from primary care and sexuality clinic samples are characteristically higher. Although a relatively large number of studies have been conducted since Spector and Carey’s (1990) review, the lack of methodological rigor of many studies limits the confidence that can be placed in these findings.

Simons, Jeffrey; Carey, Michael P.

2008-01-01

336

Human endothelial dysfunction: EDCFs  

Microsoft Academic Search

Human studies, conducted in the presence of clinical conditions characterized by endothelial dysfunction, evidenced that endothelial\\u000a cells, in response to different agonists and physical stimuli, become a source of endothelium-derived contracting factors\\u000a (EDCFs), mainly cyclooxygenase (COX)-derived prostanoids. Their production has been documented in several human diseases,\\u000a mostly in essential hypertension and aging. The EDCF production was at first identified as

Agostino Virdis; Lorenzo Ghiadoni; Stefano Taddei

2010-01-01

337

Curing erectile dysfunction: Pro  

Microsoft Academic Search

This study tested the hypothesis that sildenafil daily for 1 year can cure vascular erectile dysfunction (ED). In a prospective,\\u000a randomized controlled trial, patients were assigned to two groups: group I, 50 mg of sildenafil daily at bedtime; group II,\\u000a 50 to 100 mg of sildenafil on demand. The primary efficacy measures were International Index of Erectile Function domain score

Frank Sommer

2005-01-01

338

Microcirculatory dysfunction in sepsis.  

PubMed

Septic shock is a common and deadly disease that traditionally has been diagnosed and treated by evaluation and optimization of global hemodynamic indices. However, microcirculatory dysfunction is a critically important element in the pathophysiology of this disease. New techniques of in vivo video microscopy permit the assessment of microcirculatory function in human subjects. With the advent of these techniques, the microcirculation may represent a new frontier for developing novel therapies for sepsis. PMID:21316568

Lundy, David J; Trzeciak, Stephen

2011-03-01

339

Diabetes and Cardiac Dysfunction  

Microsoft Academic Search

\\u000a Type 2 diabetes is associated with a marked increase in cardiovascular disease. This review summarizes some of the experimental\\u000a evidence supporting the existence of a diabetic cardiomyopathy, defined as ventricular dysfunction in the absence of coronary\\u000a artery disease, in three rodent models of type 2 diabetes produced by leptin receptor mutations: diabetic db\\/db mice, diabetic ZDF fa\\/fa rats, and corpulent]CK:LA-cp\\/cp

David L. Severson; Ellen Aasum; Darrell D. Belke; Terje S. Larsen; Lisa M. Semeniuk; Yakhin Shimoni

340

Epidemiology of erectile dysfunction  

Microsoft Academic Search

This review of the current epidemiological literature on erectile dysfunction (ED) suggests that approximately 5–20% of men have moderate-to-severe ED. Different definitions of ED, age distributions and concomitant medical conditions, as well as methodological differences, may explain much of the variance in reported prevalence rates. Various chronic disorders are associated with elevated rates of ED including depression, diabetes, and cardiovascular

M Kubin; G Wagner; A R Fugl-Meyer

2003-01-01

341

Female Sexual Dysfunction  

Microsoft Academic Search

The focus of this book is men and their sexual function and dysfunction, however, many women will also develop some degree\\u000a of sexual health problems concerned with sexual desire, arousal, orgasm, and\\/or pain. The goal is to make relevant evidence-based\\u000a clinical information to help identify and treat specific biologically based pathophysiologies available to the motivated health\\u000a care professional. The prevalence

Irwin Goldstein

342

Diabetes and erectile dysfunction  

Microsoft Academic Search

Many diabetic men suffer from erectile dysfunction (ED). The etiology of diabetic impotence is complex, with neurogenic, vasculogenic,\\u000a and disordered local neuroeffector regulatory mechanisms contributing to the pathology of ED. The introduction of oral phosphodiesterase-5\\u000a inhibitors has revolutionized medical therapy for ED. These drugs have become the primary initial treatment for ED, although\\u000a the medications are less efficacious in diabetic

John Gore; Jacob Rajfer

2004-01-01

343

Soybean trypsin inhibitors in diets for Atlantic salmon (Salmo salar, L): effects on nutrient digestibilities and trypsin in pyloric caeca homogenate and intestinal content.  

PubMed

Atlantic salmon (Salmo salar, L), 180 g, were fed diets containing a crude trypsin inhibitor from soybean at five levels. The five levels resulted in trypsin inhibitor activities (TIA) corresponding to an inclusion of 0 to about 100% commercial soybean meal. Digestibility of protein and fat, weight gain and trypsin activity in intestinal content were significantly reduced with increasing dietary TIA. The response curves for nutrient digestibility and growth indicated that the Atlantic salmon were able to compensate for a certain TIA, equivalent to about 5 mg bovine trypsin inhibited per g feed. This compensation seemed to be due to increased trypsin secretion as suggested by the values for total content of trypsin in the pyloric caeca homogenate. At the highest level of TIA, the pancreatic capacity of trypsin synthesis seemed to be exhausted. PMID:7828032

Olli, J J; Hjelmeland, K; Krogdahl, A

1994-12-01

344

Thyroid dysfunction in pregnancy  

PubMed Central

Timely treatment of thyroid disease during pregnancy is important in preventing adverse maternal and fetal outcomes. Thyroid abnormalities are very often subclinical in nature and not easily recognized without specific screening programs. Even mild maternal thyroid hormone deficiency may lead to neurodevelopment complications in the fetus. The main diagnostic indicator of thyroid disease is the measurement of serum thyroid-stimulating hormone and free thyroxine levels. Availability of gestation-age-specific thyroid-stimulating hormone thresholds is an important aid in the accurate diagnosis and treatment of thyroid dysfunction. Pregnancy- specific free thyroxine thresholds not presently available are also required. Large-scale intervention trials are urgently needed to assess the efficacy of preconception or early pregnancy screening for thyroid disorders. Accurate interpretation of both antepartum and postpartum levels of thyroid hormones is important in preventing pregnancy-related complication secondary to thyroid dysfunction. This article sheds light on the best ways of management of thyroid dysfunction during pregnancy in order to prevent any possible maternal or fetal complication.

El Baba, Khalid A; Azar, Sami T

2012-01-01

345

High efficacy of biofeedback therapy for treatment of dysfunctional voiding in children  

PubMed Central

Introduction Dysfunctional voiding is a frequent condition in children associated with symptoms of incontinence. The aim of this study was to present the efficacy of biofeedback treatment on the resolution of clinical symptoms in a large cohort of children with urodynamically confirmed dysfunctional voiding. Material and methods 81 children (75 girls and 6 boys) aged 6-18 years (mean: 10.32 ±3.17 yrs.) with a dysfunctional voiding pattern are presented. 74/81 (92.6%) of children were unresponsive to standard urotherapy and prior pharmacotherapy. Symptoms of bladder dysfunction were evaluated by questionnaire, bladder diary and an urodynamic study according to definitions and standards set by ICCS. The biofeedback training was planned for 2 months. Each session consisted of about 30 repeats of 5 s contraction and 30 s relaxation of pelvic floor muscles and external urethral sphincter. Biofeedback was performed together with standard urotherapy. Results 67 (82.72%) of the 81 children declared wetting during the day and 41 (50, 62%) – wetting during the night. 32/81 (39.5%) children had increased voiding frequency and 43 (53.08%) had decreased bladder capacity. Following 2 months of biofeedback therapy daytime incontinence resolved in 34/67 (50.7%) children and nighttime incontinence in 22/41 (53.65%). A further 40,3% declared partial improvement in daytime and 26.7% in nighttime wetting. Conclusions Biofeedback treatment is an effective therapeutic option for children with dysfunctional voiding. Pelvic floor therapy with biofeedback should be offered to children with dysfunctional voiding resistant to standard urotherapy.

Maternik, Michal; Drozynska-Duklas, Magdalena; Szczesniak, Przemyslaw; Czarniak, Piotr; Golebiewski, Andrzej; Zurowska, Aleksandra

2012-01-01

346

Six-year results of a prospective, randomized trial of selective proximal vagotomy with and without pyloroplasty in the treatment of duodenal, pyloric, and prepyloric ulcers.  

PubMed Central

In a consecutive series of patients with uncomplicated prepyloric, pyloric, or duodenal ulcer, 39 patients were randomly allocated to selective proximal vagotomy with pyloroplasty, and 40 patients to selective proximal vagotomy alone with no operative mortality. Before surgery, all patients had undergone H2-receptor antagonist treatment. No patient was lost for follow-up. At an average follow-up of 6 years, recurrent ulcer was recorded in 15% and 20%, respectively, after selective proximal vagotomy with and without pyloroplasty. Three of 14 recurrent ulcers were asymptomatic. Epigastric pain with or without ulcer was significantly less common after selective proximal vagotomy with (13%) than without pyloroplasty (40%). Mild diarrhea or mild dumping was recorded in a few patients. The overall results were very good or good (Visick I or II) in 77% and 55% (significant difference) after vagotomy with and without pyloroplasty, respectively, and in 82% and 58%, if asymptomatic ulcers were graded as Visick I or II results. Of the 27 patients with Visick III or IV results, three patients needed no treatment (asymptomatic ulcers), and 10 patients had no symptoms during medical treatment. Two patients with vagotomy and pyloroplasty and nine with vagotomy alone were reoperated. There were no deaths, and the results were graded as Visick I or II in 10 patients and as Visick III in one patient. The authors conclude that selective proximal vagotomy with pyloroplasty is superior to vagotomy alone for the treatment of prepyloric-pyloric and duodenal ulcer. Recurrent ulcer after vagotomy has a benign course and responds well to ranitidine treatment.

Emas, S; Grupcev, G; Eriksson, B

1993-01-01

347

Videourodynamic and sphincter motor unit potential analyses in Parkinson's disease and multiple system atrophy  

Microsoft Academic Search

OBJECTIVESUrinary dysfunction is a prominent autonomic feature in Parkinson's disease (PD) and multiple system atrophy (MSA), which is not only troublesome but also a cause of morbidity in these disorders. Recent advances in investigative uroneurology offer a better insight into the underlying pathophysiology and appropriate management for urinary dysfunction.METHODStwenty one patients with PD (15 men, six women, mean age 64

R Sakakibara; T Hattori; T Uchiyama; T Yamanishi

2001-01-01

348

Damage to the innervation of the voluntary anal and periurethral sphincter musculature in incontinence: an electrophysiological study  

Microsoft Academic Search

In 40 women with idiopathic (neurogenic) faecal incontinence, 20 of whom also had stress urinary incontinence, single fibre EMG studies showed an increased fibre density in the external anal sphincter muscle. All these patients showed excessive descent of the pelvic floor on straining. The mean terminal motor latencies in the pudendal and perineal nerves, measured by a digitally-directed intrarectal stimulating

S J Snooks; P R Barnes; M Swash

1984-01-01

349

Anorectal incontinence and rectal prolapse: differential assessment of the innervation to puborectalis and external anal sphincter muscles  

Microsoft Academic Search

The innervation of the puborectalis and external anal sphincter muscles was studied in 32 patients with idiopathic (neurogenic) faecal incontinence, 12 of whom also had complete rectal prolapse, using transcutaneous spinal stimulation, transrectal pudendal nerve stimulation, single fibre EMG, anorectal manometry, and measurement of perineal descent. Fourteen normal subjects served as controls. Significant increases in the spinal motor latencies from

S J Snooks; M M Henry; M Swash

1985-01-01

350

Effect of Tracheotomy Tube Occlusion on Upper Esophageal Sphincter and Pharyngeal Pressures in Aspirating and Nonaspirating Patients  

Microsoft Academic Search

The biomechanics of the pharyngeal swallow in patients with a tracheotomy tube were investigated with manometry. Upper esophageal sphincter (UES) and pharyngeal pressure recordings were made with and without occlusion of the tracheotomy tube. Criteria for selection were ability to tolerate tracheotomy tube occlusion for both 5 minutes prior to and during the first manometric analysis, absence of surgery to

Steven B. Leder; John K. Joe; Susan E. Hill; Morris Traube

2001-01-01

351

Effects of electrical stimulation of the thoracic spinal cord on bladder and external urethral sphincter activity in the decerebrate cat  

Microsoft Academic Search

Electrical stimulation of the spinal cord above the sacral segments was used to produce coordinated micturition in the paralysed decerebrate cat. Stimulation of the superficial aspect of the dorsolateral funiculus (DLF) within the lower thoracic (T9-T13) segments produced a bladder contraction coordinated with decreased activity in the external urethral sphincter (EUS) branch of the pudendal nerve during which time fluid

B. Fedirchuk; S. J. Shefchyk

1991-01-01

352

Human amniotic fluid stem cell injection therapy for urethral sphincter regeneration in an animal model  

PubMed Central

Background Stem cell injection therapies have been proposed to overcome the limited efficacy and adverse reactions of bulking agents. However, most have significant limitations, including painful procurement, requirement for anesthesia, donor site infection and a frequently low cell yield. Recently, human amniotic fluid stem cells (hAFSCs) have been proposed as an ideal cell therapy source. In this study, we investigated whether periurethral injection of hAFSCs can restore urethral sphincter competency in a mouse model. Methods Amniotic fluids were collected and harvested cells were analyzed for stem cell characteristics and in vitro myogenic differentiation potency. Mice underwent bilateral pudendal nerve transection to generate a stress urinary incontinence (SUI) model and received either periurethral injection of hAFSCs, periurethral injection of Plasma-Lyte (control group), or underwent a sham (normal control group). For in vivo cell tracking, cells were labeled with silica-coated magnetic nanoparticles containing rhodamine B isothiocyanate (MNPs@SiO2 (RITC)) and were injected into the urethral sphincter region (n = 9). Signals were detected by optical imaging. Leak point pressure and closing pressure were recorded serially after injection. Tumorigenicity of hAFSCs was evaluated by implanting hAFSCs into the subcapsular space of the kidney, followed two weeks later by retrieval and histologic analysis. Results Flow activated cell sorting showed that hAFSCs expressed mesenchymal stem cell (MSC) markers, but no hematopoietic stem cell markers. Induction of myogenic differentiation in the hAFSCs resulted in expression of PAX7 and MYOD at Day 3, and DYSTROPHIN at Day 7. The nanoparticle-labeled hAFSCs could be tracked in vivo with optical imaging for up to 10 days after injection. Four weeks after injection, the mean LPP and CP were significantly increased in the hAFSC-injected group compared with the control group. Nerve regeneration and neuromuscular junction formation of injected hAFSCs in vivo was confirmed with expression of neuronal markers and acetylcholine receptor. Injection of hAFSCs caused no in vivo host CD8 lymphocyte aggregation or tumor formation. Conclusions hAFSCs displayed MSC characteristics and could differentiate into cells of myogenic lineage. Periurethral injection of hAFSCs into an SUI animal model restored the urethral sphincter to apparently normal histology and function, in absence of immunogenicity and tumorigenicity.

2012-01-01

353

Management of ejaculatory dysfunction.  

PubMed

Ejaculatory dysfunction is a common complaint and is often associated with a reduced quality of life for sufferer and partner. The spectrum of ejaculatory dysfunction extends from premature ejaculation (PE) to delayed ejaculation (DE) and anejaculation. Over the past 20-30 years, the PE treatment paradigm, previously limited to behavioural psychotherapy, has expanded to include drug treatment. Multiple well-controlled, evidence-based studies have demonstrated the efficacy and safety of selective serotonin re-uptake inhibitors in delaying ejaculation, confirming their role as first-line agents for the treatment of lifelong and acquired PE. More recently, there has been increased attention to the psychosocial consequences of PE, its epidemiology, its aetiology and its pathophysiology by both clinicians and the pharmaceutical industry. DE and anejaculation are probably the least common, least studied and least understood of the male sexual dysfunctions. However, their impact is significant as they may result in a lack of sexual fulfilment for both the man and his partner, an effect further compounded when procreation is among the couple's goals of sexual intercourse. The causes of DE, anejaculation and anorgasmia are manifold. Numerous psychotherapeutic treatments are described for the management of delayed or anejaculation. Although some appear to be effective, none has been properly evaluated in large-scale samples. Treatment of DE or anejaculation with pharmacotherapy has met with limited success. No drugs have been approved by regulatory agencies for this purpose, and most drugs that have been identified for potential use have limited efficacy, impart significant side-effects or are yet considered experimental in nature. PMID:24528812

McMahon, C G

2014-02-01

354

[Thyroid dysfunctions and pregnancy].  

PubMed

Advances in understanding the physiology of the thyroid function in normal pregnancy have highlighted the importance of the consequences of abnormal thyroid function on mother and fetal outcomes. Thyroid diseases are common in young women of childbearing age while management of thyroid diseases is relatively straightforward. For each thyroid dysfunction (hypothyroxinemia, hypothyroidism, hyperthyroidism, postpartum thyroiditis), the issues with the obstetric complications of the mother and the fetus are considered. Indeed, early recognition of thyroid diseases during pregnancy and appropriate management has the potential to improve outcome for the mother and the fetus. PMID:22078088

Caron, Philippe

2011-12-01

355

Disturbed Colonic Motility Contributes to Anorectal Symptoms and Dysfunction After Radiotherapy for Carcinoma of the Prostate  

SciTech Connect

Purpose: To evaluate the role of colonic motility in the pathogenesis of anorectal symptoms and dysfunction after radiotherapy (RT) for carcinoma of the prostate. Patients and Methods: Thirty-eight patients, median age 71 (range, 50-81) years with localized prostate carcinoma randomized to one of two radiation dose schedules underwent colonic transit scintigraphy and assessment of anorectal symptoms (questionnaire), anorectal function (manometry), and anal sphincteric morphology (endoanal ultrasound) before and at 1 month and 1 year after RT. Results: Whole and distal colonic transit increased 1 month after RT, with faster distal colonic transit only persisting at 1 year. Frequency and urgency of defecation, fecal incontinence, and rectal bleeding increased 1 month after RT and persisted at 1 year. Basal anal pressures remained unchanged, but progressive reductions occurred in anal squeeze pressures and responses to increased intra-abdominal pressure. Rectal compliance decreased progressively in the patients, although no changes in anorectal sensory function ensued. Radiotherapy had no effect on the morphology of the internal and external anal sphincters. Distal colonic retention was weakly related to rectal compliance at 1 month, but both faster colonic transit and reduced rectal compliance were more frequent with increased fecal urgency. At 1 year, a weak inverse relationship existed between colonic half-clearance time and frequency of defecation, although both faster whole-colonic transit and reduced rectal compliance occurred more often with increased stool frequency. Conclusion: Colonic dysmotility contributes to anorectal dysfunction after RT for carcinoma of the prostate. This has implications for improving the management of anorectal radiation sequelae.

Yeoh, Eric K., E-mail: eric.yeoh@health.sa.gov.a [Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA (Australia); Bartholomeusz, Dylan L. [Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, SA (Australia); Holloway, Richard H. [Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, SA (Australia); Fraser, Robert J. [Gastrointestinal Investigation Unit, Repatriation General Hospital, Daw Park, SA (Australia); Botten, Rochelle; Di Matteo, Addolorata [Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA (Australia); Moore, James W. [Department of Colorectal Surgery, Royal Adelaide Hospital, Adelaide, SA (Australia); Schoeman, Mark N. [Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, SA (Australia)

2010-11-01

356

Rectal sensorimotor dysfunction in patients with urge faecal incontinence: evidence from prolonged manometric studies  

PubMed Central

Background and aims: Although external anal sphincter dysfunction is the major cause of urge faecal incontinence, approximately 50% of such patients have evidence of rectal hypersensitivity and report exaggerated stool frequency and urgency. The contribution of rectosigmoid contractile activity to the pathophysiology of this condition is unclear, and thus the relations between symptoms, rectal sensation, and rectosigmoid motor function were investigated. Methods: Fifty two consecutive patients with urge faecal incontinence, referred to a tertiary surgical centre, and 24 volunteers, underwent comprehensive anorectal physiological investigation, including prolonged rectosigmoid manometry. Patients were classified on the basis of balloon distension thresholds into those with rectal hypersensitivity (n?=?27) and those with normal rectal sensation (n?=?25). Automated quantitative analysis of overall rectosigmoid contractile activities and, specifically, high amplitude contractions and rectal motor complex activity was performed. Results: External anal sphincter dysfunction was similar in both patient groups. Overall, phasic activity and high amplitude contraction frequency were greater, and rectal motor complex variables significantly altered, in those with rectal hypersensitivity. Symptoms, more prevalent in the rectal hypersensitivity group, were also more often associated with rectosigmoid contractile events. For individuals, reduced compliance and increased rectal motor complex frequency were only observed in patients with rectal hypersensitivity. Conclusions: We have identified a subset of patients with urge faecal incontinence—namely, those with rectal hypersensitivity—who demonstrated increased symptoms, enhanced perception, reduced compliance, and exaggerated rectosigmoid motor activity. Comprehensive assessment of rectosigmoid sensorimotor function, in addition to evaluation of anal function, should be considered in the investigation of patients with urge faecal incontinence.

Chan, C L H; Lunniss, P J; Wang, D; Williams, N S; Scott, S M

2005-01-01

357

Novel management approach to connecting tube erosion of artificial urinary sphincter.  

PubMed

Artificial urinary sphincter (AUS) erosion often involve the urethral cuff and is managed by complete or partial device removal. Abdominal wall erosion of AUS tubing has not been previously reported and its management is unknown. We report tube erosion (TE) of AUS successfully managed without device explant. An 81-year-old male with AUS for post-prostatectomy incontinence presented with TE at the site of inguinal incision without signs or symptoms of infection. The exposed tube was reduced and wound was closed after copious antibiotic solution irrigation. No complications were noted at 2 month follow up. AUS-TE can be successfully managed conservatively with antiseptic wound site irrigation and reinsertion in absence of infection. PMID:24775580

Boateng, Akwasi A; Mohamed, Mahmoud A; Mahdy, Ayman E

2014-04-01

358

Neuro-regulation of lower esophageal sphincter function as treatment for gastroesophageal reflux disease  

PubMed Central

The junction between the esophagus and the stomach is a specialized region, composed of lower esophageal sphincter (LES) and its adjacent anatomical structures, the gastric sling and crural diaphragm. Together these structures work in a coordinated manner to allow ingested food into the stomach while preventing reflux of gastric contents across the esophago-gastric junction (EGJ) into the esophagus. The same zone also permits retrograde passage of air and gastric contents into esophagus during belching and vomiting. The precise coordination required to execute such a complicated task is achieved by a finely-regulated high-pressure zone. This zone keeps the junction between esophagus and stomach continuously closed, but is still able to relax briefly via input from inhibitory neurons that are responsible for its innervation. Alterations of the structure and function of the EGJ and the LES may predispose to gastroesophageal reflux disease (GERD).

Sidhu, Anupender Singh; Triadafilopoulos, George

2008-01-01

359

[Changes in mechanical and functional processes of the lower esophageal sphincter in patients with reflux esophagitis].  

PubMed

The present study was performed to establish eventual inferences of functional and mechanical alterations of the lower esophageal sphincter (LES) in determining reflux esophagitis. The LES basal pressure, the percentual incidence of the incoordinate LES relaxations swallowing-induced, the LES overall and abdominal length, with gastroesophageal reflux disease (GERD), with and without endoscopic evidence of esophagitis, were manometrically evaluated in 117 consecutive patients. In patients with symptomatic GERD, a significant LES pressure reduction, which is inversely related to the severity of the endoscopic mucosal damage, an increased prevalence of the incoordinate LES relaxations swallowing-induced and, only in patients with esophagitis, a significant reduction of the LES overall and abdominal length of the LES, were showed. Two or three alterations of the LES antireflux devices can occur in the same patient, thus increasing the risk of esophagitis. PMID:2251450

Pustorino, S; Migliorato, D; Ianni, G; Martinez, P; Guerrisi, O; Federico, G; Luzza, G

1990-06-01

360

Distension of the esophagogastric junction augments triggering of transient lower esophageal sphincter relaxation.  

PubMed

Patients with gastroesophageal reflux disease show an increase in esophagogastric junction (EGJ) distensibility and in frequency of transient lower esophageal sphincter relaxations (TLESR) induced by gastric distension. The objective was to study the effect of localized EGJ distension on triggering of TLESR in healthy volunteers. An esophageal manometric catheter incorporating an 8-cm internal balloon adjacent to a sleeve sensor was developed to enable continuous recording of EGJ pressure during distension of the EGJ. Inflation of the balloon doubled the cross-section of the trans-sphincteric portion of the catheter from 5 mm OD (round) to 5 × 11 mm (oval). Ten healthy subjects were included. After catheter placement and a 30-min adaptation period, the EGJ was randomly distended or not, followed by a 45-min baseline recording. Subjects consumed a refluxogenic meal, and recordings were made for 3 h postprandially. A repeat study was performed on another day with EGJ distension status reversed. Additionally, in one subject MRI was performed to establish the exact position of the balloon in the inflated state. The number of TLESR increased during periods of EGJ distension with the effect being greater after a meal [baseline: 2.0(0.0-4.0) vs. 4.0(1.0-11.0), P=0.04; postprandial: 15.5(10.0-33.0) vs. 22.0(17.0-58.0), P=0.007 for undistended and distended, respectively]. EGJ distension augments meal-induced triggering of TLESR in healthy volunteers. Our data suggest the existence of a population of vagal afferents located at sites in/around the EGJ that may influence triggering of TLESR. PMID:21817061

van Wijk, Michiel P; Blackshaw, L Ashley; Dent, John; Benninga, Marc A; Davidson, Geoffrey P; Omari, Taher I

2011-10-01

361

The Relationship Between Somatic Growth and In Vivo Esophageal Segmental and Sphincteric Growth in Human Neonates  

PubMed Central

Background Measurement of aerodigestive tract length is an important determinant for accurate placement of esophageal probes and gavage tubes at the desired location. The relationship of esophageal body, upper esophageal sphincter (UES) and lower esophageal sphincter (LES) lengths with somatic growth in neonates is not well understood. Objectives Our objectives were to (1) evaluate a relationship between segmental esophageal lengths and somatic growth parameters and (2) ascertain the relationship between segmental esophageal lengths and gestational age (GA) and postmenstrual age (PMA) in preterm and full-term born human neonates. Design/Methods One hundred esophageal manometry studies were performed in 75 infants (30–60 weeks PMA) and the high-pressure zones of LES and UES identified. The distance from nares to LES and from nares to UES, esophageal body length, length of UES and LES derived from the manometry studies were correlated with somatic growth parameters. Growth rate of different esophageal segments was also determined in 26 subjects that underwent longitudinal studies. Analysis of variance and linear regression analysis were performed. Results Seventy-five neonates of 23.0–40.6 weeks gestational age (0.6–4.4 kg) were studied at 29.1–58.6 weeks PMA (1.0–6.4 kg). Significant correlation (P < 0.001) of PMA and physical growth parameters with the growth of nares-LES (R2 = 0.8), esophageal body length (R2 = 0.6) and nares-UES (R2 = 0.4) were noted. Nares-to-LES length increased at a rate of 0.25 cm/wk PMA during 33.0–36.0 weeks of age. Conclusions In vivo esophageal segmental lengths correlated strongly with somatic growth parameters and PMA in neonates. We speculate that this approach has many practical applications with the use of esophageal probes and catheters.

Gupta, Alankar; Jadcherla, Sudarshan Rao

2014-01-01

362

Urethral sphincter EMG-controlled dorsal penile/clitoral nerve stimulation to treat neurogenic detrusor overactivity  

NASA Astrophysics Data System (ADS)

The goal of this study was to investigate whether real-time external urethral sphincter (EUS) EMG-controlled dorsal genital nerve (DGN) stimulation can suppress undesired detrusor bladder contractions in patients with both neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD). Detrusor pressure (Pdet) and EUS EMG were recorded in 12 neurogenic patients who underwent two filling cystometries. The first one was without stimulation and was intended to confirm the NDO and DSD and to set the EMG detection threshold. The second one was with real-time EMG-controlled stimulation of DGNs. Two detection methods were analyzed to detect bladder contractions. The first method was a Kurtosis-scaled root mean square (RMS) detector and was used on-line. The second was a simple RMS detector and was used off-line. Of 12 patients included, 10 patients showed both NDO and DSD. In nine of these ten patients relevant EMG concomitant to detrusor activity was detected and stimulation could suppress at least one detrusor contraction. The second filling compared to the first one showed an increase of 84% in bladder capacity (p = 0.002) and a decrease of 106% in Pdet (p = 0.002). Nine false-positive detections occurred during the ten fillings with electrical stimulation. The mean increases of both time and Pdet between stimulation and bladder contraction onsets for method 1 were 1.8 s and 4 cmH2O and for method 2 were 0.9 s and 2 cmH2O, respectively. This study shows that EUS EMG can be used in real time to detect the onset of a bladder contraction. In combination with DGN stimulation has been shown to be feasible to suppress undesired bladder contractions and in turn to increase bladder capacity in subjects with both NDO and DSD.

Opisso, E.; Borau, A.; Rijkhoff, N. J. M.

2011-06-01

363

Urethral sphincter EMG-controlled dorsal penile/clitoral nerve stimulation to treat neurogenic detrusor overactivity.  

PubMed

The goal of this study was to investigate whether real-time external urethral sphincter (EUS) EMG-controlled dorsal genital nerve (DGN) stimulation can suppress undesired detrusor bladder contractions in patients with both neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD). Detrusor pressure (Pdet) and EUS EMG were recorded in 12 neurogenic patients who underwent two filling cystometries. The first one was without stimulation and was intended to confirm the NDO and DSD and to set the EMG detection threshold. The second one was with real-time EMG-controlled stimulation of DGNs. Two detection methods were analyzed to detect bladder contractions. The first method was a Kurtosis-scaled root mean square (RMS) detector and was used on-line. The second was a simple RMS detector and was used off-line. Of 12 patients included, 10 patients showed both NDO and DSD. In nine of these ten patients relevant EMG concomitant to detrusor activity was detected and stimulation could suppress at least one detrusor contraction. The second filling compared to the first one showed an increase of 84% in bladder capacity (p = 0.002) and a decrease of 106% in Pdet (p = 0.002). Nine false-positive detections occurred during the ten fillings with electrical stimulation. The mean increases of both time and Pdet between stimulation and bladder contraction onsets for method 1 were 1.8 s and 4 cmH(2)O and for method 2 were 0.9 s and 2 cmH(2)O, respectively. This study shows that EUS EMG can be used in real time to detect the onset of a bladder contraction. In combination with DGN stimulation has been shown to be feasible to suppress undesired bladder contractions and in turn to increase bladder capacity in subjects with both NDO and DSD. PMID:21464521

Opisso, E; Borau, A; Rijkhoff, N J M

2011-06-01

364

Investigation of the distribution and function of ?-adrenoceptors in the sheep isolated internal anal sphincter  

PubMed Central

BACKGROUND AND PURPOSE We have investigated the distribution of ?-adrenoceptors in sheep internal anal sphincter (IAS), as a model for the human tissue, and evaluated various imidazoline derivatives for potential treatment of faecal incontinence. EXPERIMENTAL APPROACH Saturation and competition binding with 3H-prazosin and 3H-RX821002 were used to confirm the presence and density of ?-adrenoceptors in sheep IAS, and the affinity of imidazoline compounds at these receptors. A combination of in vitro receptor autoradiography and immunohistochemistry was used to investigate the regional distribution of binding sites. Contractile activity of imidazoline-based compounds on sheep IAS was assessed by isometric tension recording. KEY RESULTS Saturation binding confirmed the presence of both ?1- and ?2-adrenoceptors, and subsequent characterization with sub-type-selective agents, identified them as ?1A- and ?2D-adrenoceptor sub-types. Autoradiographic studies with 3H-prazosin showed a positive association of ?1-adrenoceptors with immunohistochemically identified smooth muscle fibres. Anti-?1-adrenoceptor immunohistochemistry revealed similar distributions of the receptor in sheep and human IAS. The imidazoline compounds caused concentration-dependent contractions of the anal sphincter, but the maximum responses were less than those elicited by l-erythro-methoxamine, a standard non-imidazoline ?1-adrenoceptor agonist. Prazosin (selective ?1-adrenoceptor antagonist) significantly reduced the magnitude of contraction to l-erythro-methoxamine at the highest concentration used. Both prazosin and RX811059 (a selective ?2-adrenoceptor antagonist) reduced the potency (pEC50) of clonidine. CONCLUSIONS AND IMPLICATIONS This study shows that both ?1- and ?2-adrenoceptors are expressed in the sheep IAS, and contribute (perhaps synergistically) to contractions elicited by various imidazoline derivatives. These agents may prove useful in the treatment of faecal incontinence.

Rayment, SJ; Eames, T; Simpson, JAD; Dashwood, MR; Henry, Y; Gruss, H; Acheson, AG; Scholefield, JH; Wilson, VG

2010-01-01

365

TRANSIENT LOWER ESOPHAGEAL SPHINCTER RELAXATION IN ACHALASIA: EVERYTHING BUT LES RELAXATION  

PubMed Central

Background: In conducting clinical high resolution esophageal pressure topography (HREPT) studies we observed that after subjects sat upright between series of supine and upright test swallows, they frequently had a transient lower esophageal sphincter relaxation (tLESR). When achalasia patients were studied in the same protocol, they exhibited a similar HREPT event leading to the hypothesis that achalasics had incomplete tLESRs. Methods: We reviewed clinical HREPT studies of 94 consecutive non-achalasics and 25 achalasics. Studies were analyzed for a tLESR-like event during the study and, when observed, that tLESR-like event was characterized for the degree and duration of distal esophageal shortening, the degree of LES relaxation, associated crural diaphragm (CD) inhibition, esophageal pressurization, and upper esophageal sphincter (UES) relaxation. Results: 64/94 (68%) non-achalasics and 15/24 (63%) of achalasics had a pressure topography event after the posture change characterized by a prolonged period of distal esophageal shortening and/or LES relaxation. Events among the non-achalasics and achalasics were similar in terms of magnitude and duration of shortening and all were associated with CD inhibition. Similar proportions had associated non-deglutitive UES relaxations. The only consistent differences were the absence of associated LES relaxation and the absence of HREPT evidence of reflux among the achalasics leading us to conclude that their events were incomplete tLESRs. Conclusions: Achalasic patients exhibit a selective defect in the tLESR response suggesting preservation of all sensory, central, and efferent aspects of the requisite neural substrate with the notable exception of LES relaxation, a function of inhibitory (nitrergic) myenteric plexus neurons.

KWIATEK, Monika A.; POST, Jennifer; PANDOLFINO, John E.; KAHRILAS, Peter J.

2009-01-01

366

Mitochondrial dysfunction during sepsis.  

PubMed

Sepsis and multiple organ failure remain leading causes of death in intensive care patients. Recent advances in our understanding of the pathophysiology of these syndromes include a likely prominent role for mitochondria. Patient studies have shown that the degree of mitochondrial dysfunction is related to the eventual outcome. Associated mechanisms include damage to mitochondria or inhibition of the electron transport chain enzymes by nitric oxide and other reactive oxygen species (the effects of which are amplified by co-existing tissue hypoxia), hormonal influences that decrease mitochondrial activity, and downregulation of mitochondrial protein expression. Notably, despite these findings, there is minimal cell death seen in most affected organs, and these organs generally regain reasonably normal function should the patient survive. It is thus plausible that multiple organ failure following sepsis may actually represent an adaptive state whereby the organs temporarily 'shut down' their normal metabolic functions in order to protect themselves from an overwhelming and prolonged insult. A decrease in energy supply due to mitochondrial inhibition or injury may trigger this hibernation/estivation-like state. Likewise, organ recovery may depend on restoration of normal mitochondrial respiration. Data from animal studies show histological recovery of mitochondria after a septic insult that precedes clinical improvement. Stimulation of mitochondrial biogenesis could offer a new therapeutic approach for patients in multi-organ failure. This review will cover basic aspects of mitochondrial function, mechanisms of mitochondrial dysfunction in sepsis, and approaches to prevent, mitigate or speed recovery from mitochondrial injury. PMID:20509844

Azevedo, Luciano Cesar Pontes

2010-09-01

367

[Differentiation of the effects of antispasmodic agents on the electromyogram of the sphincter of Oddi and the duodenum of the alert rabbit].  

PubMed

The electrical activity of the sphincter of Oddi and gastro-intestinal tract had been recorded on 21 negative atropineesterase conscious rabbits by means of chronically implanted electrodes located in the digestive wall. An analysis of the action of different spasmolytic and analgesic drugs was realized. Electromyograms of the sphincter of Oddi presented (a) isolated or in series spike potentials occurring independently of electrical activities of the duodenum (b) recurring spike potentials correlated with intestine spikes. The independent activity of the sphincter of Oddi was not controlled by the cholinergic system, contrary to the intestine-dependent activity (effect of the fempiverinium, atropine like drug). The pitofenone had inhibited the spike potentials of both the sphincter and intestine because its papaverinic effect. The noramidopyrine, analgesic drug without morphine-like effects, had induced activation and inhibition at low and high posology respectively. PMID:2938675

Achard, F; Denavit, M; Roche, M

1985-01-01

368

Bladder Dysfunction and Vesicoureteral Reflux  

PubMed Central

In this overview the influence of functional bladder disturbances and of its treatment on the resolution of vesicoureteral reflux (VUR) in children is discussed. Historically both bladder dysfunction entities, the overactive bladder (OAB) and the dysfunctional voiding (DV), have been described in conjunction with VUR. Treatment of the dysfunction was also considered to influence spontaneous resolution in a positive way. During the last decades, however, papers have been published which could not support these results. Regarding the OAB, a prospective study with treatment of the bladder overactivity with anticholinergics, did not influence spontaneous resolution rate in children with a dysfunction including also the voiding phase, DV and DES (dysfunctional elimination syndrome), most studies indicate a negative influence on the resolution rate of VUR in children, both before and after the age for bladder control, both with and without treatment. However, a couple of uncontrolled studies indicate that there is a high short-term resolution rate after treatment with flow biofeedback. It should be emphasized that the voiding phase dysfunctions (DV and DES) are more severe than the genuine filling phase dysfunction (OAB), with an increased frequency of UTI and renal damage in the former groups. To be able to answer the question if treatment of bladder dysfunction influence the resolution rate of VUR in children, randomized controlled studies must be performed.

Sillen, Ulla

2008-01-01

369

Investigation of erectile dysfunction  

PubMed Central

Erectile dysfunction (ED) represents a common and debilitating condition with a wide range of organic and non-organic causes. Physical aetiologies can be divided into disorders affecting arterial inflow, the venous occlusion mechanism or the penile structure itself. Various imaging modalities can be utilised to investigate the physical causes of ED, but penile Doppler sonography (PDS) is the most informative technique, indicated in those patients with ED who do not respond to oral pharmacological agents (e.g. phosphodiesterase type 5 inhibitors). This review will examine the anatomical and physiological basis of penile erection, the method for performing PDS and features of specific causes of ED, and will also consider the alternative imaging modalities available.

Patel, D V; Halls, J; Patel, U

2012-01-01

370

Dysfunctional uterine bleeding.  

PubMed Central

Abnormal uterine bleeding is a common, debilitating condition. Dysfunctional uterine bleeding (DUB) is the diagnosis given to women with abnormal uterine bleeding in whom no clear etiology can be identified. DUB has been observed in both ovulatory and anovulatory cycles. Medical treatments include nonsteroidal anti-inflammatory drugs, oral contraceptive pills, progestins, danazol (a synthetic androgen), GnRH agonists, and antifibrinolytic drugs. The drawback to medical therapy, in addition to side effects, is that the benefit lasts only while the patient takes the medication. Surgical options have concentrated mainly on endometrial ablation and hysterectomy, and it is unclear whether one is superior to the other in terms of long-term outcome and patient satisfaction. Newer and less invasive ablation techniques, such as thermal balloon ablation, offer more treatment alternatives.

Chen, B H; Giudice, L C

1998-01-01

371

Dysfunctional uterine bleeding.  

PubMed

Abnormal uterine bleeding is a common, debilitating condition. Dysfunctional uterine bleeding (DUB) is the diagnosis given to women with abnormal uterine bleeding in whom no clear etiology can be identified. DUB has been observed in both ovulatory and anovulatory cycles. Medical treatments include nonsteroidal anti-inflammatory drugs, oral contraceptive pills, progestins, danazol (a synthetic androgen), GnRH agonists, and antifibrinolytic drugs. The drawback to medical therapy, in addition to side effects, is that the benefit lasts only while the patient takes the medication. Surgical options have concentrated mainly on endometrial ablation and hysterectomy, and it is unclear whether one is superior to the other in terms of long-term outcome and patient satisfaction. Newer and less invasive ablation techniques, such as thermal balloon ablation, offer more treatment alternatives. PMID:9830356

Chen, B H; Giudice, L C

1998-11-01

372

COGNITIVE DYSFUNCTION IN DEPRESSION  

PubMed Central

Cognitive Dysfunction' was assessed in 30patients diagnosed to have Major Depression (DSM III R), using the PCI memory scale and the Wechsler Adult Performance Intelligence Scale, form PR both of which have been developed and standardised in India. Depressed patients revealed marked impairment on tests of attention and concentration, and immediate and delayed recall on tests of memory (PCI); while tests of performance (WAPIS) revealed global impairment. This impairment reversed with recovery from depression. While improved test scores occured along with improvement in depression, there was no direct correlation between the two i.e. the degree of improvement in WAPIS/PGI total scores was not directly proportional to the degree of improvement in depression scores.

John, Sajiv; Kuruvilla, K.

1992-01-01

373

Hyperhomocysteinemia and Endothelial Dysfunction  

PubMed Central

Hyperhomocysteinemia (HHcy) is a significant and independent risk factor for cardiovascular diseases. Endothelial dysfunction (ED) is the earliest indicator of atherosclerosis and vascular diseases. We and others have shown that HHcy induced ED in human and in animal models of HHcy induced by either high-methionine load or genetic deficiency. Six mechanisms have been suggested explaining HHcy-induced ED. These include 1) nitric oxide inhibition, 2) prostanoids regulation, 3) endothelium-derived hyperpolarizing factors suppression, 4) angiotensin II receptor-1 activation, 5) endothelin-1 induction, and 6) oxidative stress. The goal of this review is to elaborate these mechanisms and to discuss biological and molecular events related to HHcy-induced ED.

Cheng, Zhongjian; Yang, Xiaofeng; Wang, Hong

2010-01-01

374

Mitochondrial dysfunction in epilepsy.  

PubMed

Epilepsy is the most common neurologic disorder worldwide and is characterized by recurrent unprovoked seizures. The mitochondrial (mt) respiratory chain is the final common pathway for cellular energy production through the process of oxidative phosphorylation. As neurons are terminally differentiated cells that lack significant regenerative capacity and have a high energy demand, they are more vulnerable to mt dysfunction. Therefore, epileptic seizures have been well described in several diseases such as mt encephalomyopathy, lactic acidosis, and stroke-like episodes and myoclonic epilepsy and ragged red fibers, which are caused by gene mutations in mtDNA, among others. Mutations in nuclear DNA regulating mt function are also being described (eg, POLG gene mutation). The role of mitochondria (mt) in acquired epilepsies, which account for about 60% of all epilepsies, is equally important but less well understood. Oxidative stress is one of the possible mechanisms in the pathogenesis of epilepsy resulting from mt dysfunction gradually disrupting the intracellular Ca(2+) homeostasis, which modulates neuronal excitability and synaptic transmission, making neurons more vulnerable to additional stress, and leading to energy failure and neuronal loss in epilepsy. Antiepileptic drugs (AEDs) also affect mt function in several ways. There must be caution when treating epilepsy in patients with known mt disorders as some AEDs are toxic to the mt. This review summarizes our current knowledge of the effect of mt disorders on epilepsy, of epileptic seizures on mt, and of AEDs on mt function and the implications of all these interactions for the management of epilepsy in patients with or without mt disease. PMID:24331359

Khurana, Divya S; Valencia, Ignacio; Goldenthal, Michael J; Legido, Agustín

2013-09-01

375

Endosonographic and manometric evaluation of internal anal sphincter in patients with chronic anal fissure and its correlation with clinical outcome after topical glyceryl trinitrate therapy  

Microsoft Academic Search

Background and aims  Anorectal pressure studies have demonstrated internal anal sphincter (IAS) hypertonia in patients with chronic anal fissure.\\u000a It is unknown however, if these changes in IAS function are associated with any abnormality in sphincter morphology. The first\\u000a aim was to investigate the clinical characteristics and the manometric and endosonographic findings of the IAS in a cohort\\u000a of patients with

Marta Pascual; Miguel Pera; Ricard Courtier; Mariá José Gil; David Parés; Sonia Puig; Montserrat Andreu; Luis Grande

2007-01-01

376

Preservation of complete anal sphincteric proprioception in restorative proctocolectomy: the inhibitory reflex and fine control of continence need not be impaired  

Microsoft Academic Search

This study evaluates whether reflux function of the anal sphincter remains unchanged after restorative proctocolectomy, provided that the sphincter remaining is kept intact, without mucosal stripping or endo-anal anastomosis. Paired tests of anorectal function were performed before, and a median of 6 (range 2-12) months after restorative proctocolectomy with stapled, end to end pouch-anal anastomosis. Beforehand, distension of the rectum

W G Lewis; M E Williamson; A S Miller; P M Sagar; P J Holdsworth; D Johnston

1995-01-01

377

[The experience of treatment with medicines of botulinum toxin of type A Lantox of chronic anal fissure with sphincter spasm].  

PubMed

The original material of monitoring of 118 patients with chronic anal fissure is presented in the article. Patients' mean age was 48.9+-10.5 years. It was used injections of medicine of botulinum toxin of type A (Lantox) by its introduction in internal anal sphincter in all patients. There was granulating wound with signs of marginal epithelialization in 59.3% of cases on the 10th day after injection. It was detected complete epithelialization of dermis defect in 93.2% of cases on the 21st day, after six weeks - in 100% of cases. According to anorectal profilometry the index of maximal and average pressure in the anal canal at the level of the internal sphincter in patients at rest decreased to norm. Lantox introduction leads to rapid and persistent reduction of pain intensity. "Lantox" use in ambulatory practice permits to minimize the indications for surgical treatment. PMID:24736539

2014-01-01

378

Effect of low and high fat meals on lower esophageal sphincter motility and gastroesophageal reflux in healthy subjects  

Microsoft Academic Search

OBJECTIVE:The reported effects of fatty meals on lower esophageal sphincter pressure (LESP) and gastroesophageal reflux (GER) are controversial. Therefore, the aim of the present study was to reevaluate the effect of isocaloric and isovolumetric low and high fat meals on LESP and GER.METHODS:Twelve healthy volunteers (six women, six men, 19 to 31 yr) received an isocaloric (842 kcal) solid–liquid (310

C Pehl; A Waizenhoefer; B Wendl; T Schmidt; W Schepp; A Pfeiffer

1999-01-01

379

Study of the mechanisms involved in the bradykinin-induced contraction of the pig iris sphincter muscle in vitro.  

PubMed

This study was designed to investigate the mechanisms by which bradykinin induces contraction of the pig iris sphincter muscle in vitro. Addition of bradykinin, Lys-bradykinin and Met-Lys-bradykinin to the pig iris sphincter resulted in a graded contraction with a mean EC(50s) of 21, 11 and 5 nM, respectively. The bradykinin B(1) receptor agonist des-Arg(9)-bradykinin only caused a slight contraction, measured 6 h after the tissue was set up. The B(2) receptor antagonists FR 173657 ((E)-3-(6-acetamido-3-pyridyl)-N [N-2-4-dichloro-3-[(2-methyl-8-quinolinyl) oxymethyl] phenyl]-N-methylamino-carbonyl-ethyl] acrylamide) and Hoe 140 (D-Arg(0)-[Hyp(3), Thi(5), D-Tic(7), Oic(8)]-bradykinin produced a graded shift to the right associated with marked inhibition of the bradykinin-induced contraction. Atropine, guanethidine or tetrodotoxin significantly reduced the bradykinin-induced contraction. Dazoxiben, an inhibitor of thromboxane A(2), and MK-571 (3-(3-(2-(7-chloro-2-quinolinyl) ethenyl) phenyl ((3-dimethyl amino-3oxo-propyl) thio) methyl) propanoic acid, a leukotriene D(4) receptor-selective antagonist, also caused inhibition of the bradykinin-mediated contraction. Cyclooxygenase-1 and -2 inhibitors, indomethacin, ibuprofen, valeryl salicylate and NS 398 (N-[2-(cyclohexyloxy)-4-nitrophenyl]methanosulfonamide) all significantly inhibited the bradykinin-mediated contraction without affecting the carbachol-induced contraction of the pig iris sphincter. Taken together, these results indicate that the bradykinin-mediated contraction of the pig iris sphincter muscle seems to be mediated primarily by the activation of the B(2) receptor release of acetylcholine, noradrenaline and both cyclooxygenase-1 and -2 metabolites besides the release of leukotriene D(4) and tromboxane A(2) from the arachidonic acid pathway. PMID:12498923

El Sayah, Mariem; Calixto, João B

2003-01-01

380

Nitinol Stents for Palliative Treatment of Malignant Obstructive Jaundice: Should We Stent the Sphincter of Oddi in Every Case?  

Microsoft Academic Search

Purpose: To evaluate the necessity of metallic stenting of the sphincter of Oddi in malignant obstructive jaundice when the tumor is more than 2 cm from the papilla of Vater.Methods: Sixty-seven self-expandable biliary stents were used in 60 patients with extrahepatic lesions of the common hepatic or common bile duct and with the distal margin of the tumor located more

Adam A. Hatzidakis; Dimitris Tsetis; Evangelia Chrysou; Elias Sanidas; John Petrakis; Nicholas C. Gourtsoyiannis

2001-01-01

381

Obstetric Sphincter Injury Interacts with Diarrhea and Urgency to Increase the Risk of Fecal Incontinence in Women with IBS  

PubMed Central

Objectives To confirm that fecal urgency and diarrhea are independent risk factors for fecal incontinence (FI), to identify obstetrical risk factors associated with FI in women with IBS (irritable bowel syndrome), and to determine whether obstetric anal sphincter injuries interact with diarrhea or urgency to explain the occurrence of FI. Methods The study is a supplement to a diary study of bowel symptoms in 164 female patients with IBS. Subjects completed daily bowel symptom diaries for 90 consecutive days and rated each bowel movement (BM) for stool consistency and presence of urgency, pain, and FI. All female participants from the parent study were invited to complete a telephone-administered 33-item bowel symptom and obstetric history questionnaire which included the Fecal Incontinence Severity Index (FISI). Results Out of 164 women in the parent study, 115 (70.1%) completed the interview. Seventy-four (45.1%) reported FI on their diary including 34 (29.6%) who reported at least one episode per month, 112 (97.4%) reported episodes of urgency, and 106 (92.2%) reported episodes of diarrhea. The mean FISI score was 13.9±9.7. Upon multivariable analysis, FI was significantly associated with parity (p=0.007), operative vaginal delivery (p=0.049), obstetrical sphincter lacerations (p=0.007), fecal urgency (p=0.005), diarrhea (p=0.008), and hysterectomy (p=0.004), but was not associated with episiotomy, pelvic organ prolapse, or urinary incontinence. The synergistic interactions of obstetric anal sphincter laceration with urgency (p=0.002) and diarrhea (p=0.004) were significant risk factors for FI. Conclusion Fecal urgency and diarrhea are independent risk factors for FI, and they interact with obstetric anal sphincter laceration to amplify the risk of FI.

Robinson, Barbara L.; Matthews, Catherine A.; Palsson, Olafur S; Geller, Elizabeth; Turner, Marsha; Parnell, Brent; Crane, Andrea; Jannelli, Mary; Wells, Ellen; Connolly, AnnaMarie; Lin, Feng-Chang; Whitehead, William E.

2014-01-01

382

Narcotic analgesic effects on the sphincter of Oddi: a review of the data and therapeutic implications in treating pancreatitis  

Microsoft Academic Search

OBJECTIVE:Traditional teaching dictates that morphine induces “spasm” in the sphincter of Oddi (SO) and should not be used in acute pancreatitis and that meperidine is the analgesic of choice because it does not elevate SO pressures. A literature search and review was performed to evaluate this teaching examining the effect of narcotic analgesic’s effects on SO.METHODS:A Medline search was performed

Donald R Thompson

2001-01-01

383

Effect of feeding on myoelectric activity of the sphincter of oddi and the gastrointestinal tract in the opossum  

Microsoft Academic Search

The effect of different foods on the myoelectric activity of the sphincter of Oddi and gastrointestinal tract was evaluated\\u000a in the opossum. Gallbladder pressure was also recorded. Feeding fat and mixed food resulted in the greatest incidence of spike\\u000a activity in the duodenum and jejunum, followed by protein. The lowest incidence of slow waves with spikes in the duodenum\\u000a and

Julio C. U. Coelho; Dirk J. Gouma; Frank G. Moody; Jerry F. Schlegel

1986-01-01

384

Understanding brain dysfunction in sepsis.  

PubMed

Sepsis often is characterized by an acute brain dysfunction, which is associated with increased morbidity and mortality. Its pathophysiology is highly complex, resulting from both inflammatory and noninflammatory processes, which may induce significant alterations in vulnerable areas of the brain. Important mechanisms include excessive microglial activation, impaired cerebral perfusion, blood-brain-barrier dysfunction, and altered neurotransmission. Systemic insults, such as prolonged inflammation, severe hypoxemia, and persistent hyperglycemia also may contribute to aggravate sepsis-induced brain dysfunction or injury. The diagnosis of brain dysfunction in sepsis relies essentially on neurological examination and neurological tests, such as EEG and neuroimaging. A brain MRI should be considered in case of persistent brain dysfunction after control of sepsis and exclusion of major confounding factors. Recent MRI studies suggest that septic shock can be associated with acute cerebrovascular lesions and white matter abnormalities. Currently, the management of brain dysfunction mainly consists of control of sepsis and prevention of all aggravating factors, including metabolic disturbances, drug overdoses, anticholinergic medications, withdrawal syndromes, and Wernicke's encephalopathy. Modulation of microglial activation, prevention of blood-brain-barrier alterations, and use of antioxidants represent relevant therapeutic targets that may impact significantly on neurologic outcomes. In the future, investigations in patients with sepsis should be undertaken to reduce the duration of brain dysfunction and to study the impact of this reduction on important health outcomes, including functional and cognitive status in survivors. PMID:23718252

Sonneville, Romain; Verdonk, Franck; Rauturier, Camille; Klein, Isabelle F; Wolff, Michel; Annane, Djillali; Chretien, Fabrice; Sharshar, Tarek

2013-01-01

385

Shiftwork and metabolic dysfunction.  

PubMed

Many of the health problems that are more prevalent among shiftworkers are thought to be linked to their heightened susceptibility to metabolic syndrome, i.e., the association of even moderate degrees of visceral obesity, dyslipidemia, abnormal blood pressure, and serum glucose levels in the same individual. Although previous studies have identified associations between shiftwork and metabolic syndrome, there is relatively little evidence to date of how the risk of developing it varies as a function of exposure to shiftwork. The current study seeks to confirm earlier findings of an association between shiftwork exposure and metabolic dysfunction, and to examine the impact of exposure duration, while adjusting for a number of covariates in the analyses. The analyses were based on data from VISAT, a study involving the measurement of physiological, behavioral, and subjective outcomes from 1757 participants, 989 being current or former shiftworkers. The sample comprised employed and retired wage earners, male and female, who were 32, 42, 52, and 62 yrs old. The first analysis sought to confirm previous findings of an association between exposure to shiftwork and the risk of developing metabolic syndrome. It indicated that participants who were or who had previously been shiftworkers (i.e., working schedules that involved rotating shifts; not being able to go to bed before midnight; having to get up before 05:00 h; or being prevented from sleeping during the night) were more likely to exhibit symptoms of metabolic syndrome, after adjusting for age, sex, socioeconomic status, smoking, alcohol intake, perceived stress, and sleep difficulty (odds ratio [OR] 1.78; 95% confidence interval [CI] 1.03-3.08). The results suggest the association between shiftwork and metabolic syndrome cannot be fully accounted for by either higher levels of strain or increased sleep difficulty among shiftworkers, although it remains a possibility that either one or both of these factors may have played a contributing role. The second analysis addressed the issue of duration of exposure to shiftwork. Participants with >10 yrs' experience of working rotating shifts were more likely to exhibit symptoms of metabolic syndrome than participants without exposure to shiftwork, i.e., dayworkers, even after adjusting for age and sex (OR 1.96; 95% CI 1.03-3.75). Thus, the current study confirms the association between shiftwork exposure and metabolic syndrome. It also provides new information regarding the time course of the development of the illness as function of exposure duration, although this was only examined in relation to rotating shiftwork. It is concluded that those responsible for monitoring workers' health should pay particular attention to indices of metabolic dysfunction in workers who have been exposed to shiftwork for >10 yrs. PMID:22621350

Tucker, Philip; Marquié, Jean-Claude; Folkard, Simon; Ansiau, David; Esquirol, Yolande

2012-06-01

386

[Factors influencing pharynx' and pharyngoesophageal sphincter's morphology and their function after total laryngectomy].  

PubMed

The usefulness of the videolaryngoscopy in patients after total laryngectomy/laryngopharyngectomy was discussed. They serve for: a) evaluation of the pharynx and of the pharyngoesophageal sphincter (pes) morphology, b) prognosis of the esophageal speech developing. In the study videolaryngoscopy was done in 82 patients (7 female and 75 male). In 62 of them total laryngectomy was done (among them in 50/62--with standard pharynx suture, in 9/62--with the pes plasty, and 3/62--with simple pes myotomy). In 20 case of laryngopharyngectomies--4/20 standard pharynx suture was done, 12/20 were reconstructed with tongue flap, 3/20--with pes plasty, and in 1/20 simple myotomy was performed. The investigations were carried out between 1 to 36 months after total laryngectomy and 24 month after laryngopharyngectomy. The analysis of the videolaryngoscopy imagings revealed that the pharynx and pes morphology after laryngectomy/laryngopharyngectomy (shape, thickness of the mucose, weakened wall peristalsis, secretion retention, lack or presence of the pes relaxation at the time of examination) correlates with the rest pressure in the pes area, measured by Seeman's method and with the occurrence of the esophageal speech mastering. The most significant changes in morphology and function of the pharynx (irregular shape, weakened wall peristalsis, retention of secretion) as well as the highest pressure in the area (5.1 +/- 3.33 kPa-38 +/- 25 mm Hg) was found after pharyngolaryngectomy. The shape of the pharynx in all the patients after laryngectomy with plasty or simple myotomy of the pes was regular, with thin and smooth mucosa while the rest pressure was low (3.0 +/- 1.18 kPa(-)+/- 22.5 +/- 8.8 mm Hg). In the analyzed material at the rest pressure in the sphincter area from 0.7 to 4kPa (from 5 to 30 mm Hg), 93% (41/44) of the patients have mastered the esophageal speech. It was stressed that videolaryngoscopy is entirely sufficient for the approximate assessment of the rest pressure in the pes area and prognosis of the esophageal speech development process. PMID:14994616

Tarnowska, Czes?awa; Sta?czyk, Dorota; Jaworowska, Ewa; Paradowska, Beata; Firlit, Katarzyna

2003-01-01

387

Interactions of bombesin and substance P at the feline lower esophageal sphincter.  

PubMed Central

The purpose of this study was to determine the interactions between bombesin and substance P at the feline lower esophageal sphincter (LES). Intraluminal pressures were recorded using a fixed, perfused catheter assembly. Myoelectrical activity was recorded using bipolar Ag-AgCl serosal electrodes. Bombesin, i.v., gave a dose-dependent increase in LES pressure and electronically counted spike activity. The threshold dose was 10(-7) g/kg, while the maximal dose, 10(-5) g/kg, increased LES pressure by 65.5 +/- 14.8 mmHg. The neuroantagonist, tetrodotoxin, decreased the LES response to bombesin by 74.1% +/- 7.9% (P less than 0.05), but had no significant effect on the LES response to substance P. The sphincteric response to bombesin was not inhibited by bilateral cervical vagotomy, atropine, propranolol, or phentolamine (P less than 0.10). Bombesin tachyphylaxis abolished the LES response to bombesin but had no effect on the response to substance P. Conversely, substance P tachyphylaxis completely abolished the LES response to bombesin (P less than 0.001). The substance P antagonist [D-Pro2, D-Trp7,9]substance P also significantly inhibited the LES response to bombesin (P less than 0.05). Acidification of the distal esophagus with 2.0 ml of 0.1 N HCl increased LES pressure by 32.5 +/- 5.2 mmHg (P less than 0.02). The LES response to acid was inhibited by bombesin tachyphylaxis (maximal pressure response, 4.7 +/- 2.1 mmHg, P less than 0.01 compared with control acid response). The tachyphylaxis techniques were specific for the peptides giving no effect on the LES responses to phenylephrine, bethanechol, or pentagastrin. We drew the following conclusions: (a) bombesin increased feline LES pressure via nonvagal neural pathways that were insensitive to adrenergic or cholinergic antagonists; (b) bombesin may be involved in the enteric pathways that mediate the feline LES response to distal esophageal acidification; and (c) substance P mediates the effect of bombesin at the LES and is a neurotransmitter in the LES response to acidification.

Reynolds, J C; Dukehart, M R; Ouyang, A; Cohen, S

1986-01-01

388

Mitochondrial dysfunction in gliomas.  

PubMed

Mitochondrial (mt) dysfunction in gliomas has been linked to abnormalities of mt energy metabolism, marked by a metabolic shift from oxidative phosphorylation to glycolysis ("Warburg effect"), disturbances in mt membrane potential regulation and apoptotic signaling, as well as to somatic mutations involving the Krebs cycle enzyme isocitrate dehydrogenase. Evolving biological concepts with potential therapeutic implications include interaction between microtubule proteins and mitochondria (mt) in the control of closure of voltage-dependent anion channels and in the regulation of mt dynamics and the mt-endoplasmic reticulum network. The cytoskeletal protein ?III-tubulin, which is overexpressed in malignant gliomas, has emerged as a prosurvival factor associated in part with mt and also as a marker of chemoresistance. Mt-targeted therapeutic strategies that are discussed include the following: (1) metabolic modulation with emphasis on dichloroacetate, a pyruvate dehydrogenase kinase inhibitor; (2) tumor cell death via apoptosis induced by tricyclic antidepressants, microtubule-modulating drugs, and small molecules or compounds capable of inflicting reactive oxygen species-dependent tumor cell death; and (3) pretreatment mt priming and mt-targeted prodrug cancer therapy. PMID:24331363

Katsetos, Christos D; Anni, Helen; Dráber, Pavel

2013-09-01

389

Adenosine dysfunction in epilepsy  

PubMed Central

Extracellular levels of the brain’s endogenous anticonvulsant and neuroprotectant adenosine largely depend on an astrocyte-based adenosine cycle, comprised of ATP release, rapid degradation of ATP into adenosine, and metabolic reuptake of adenosine through equilibrative nucleoside transporters and phosphorylation by adenosine kinase (ADK). Changes in ADK expression and activity therefore rapidly translate into changes of extracellular adenosine, which exerts its potent anticonvulsive and neuroprotective effects by activation of pre- and postsynaptic adenosine A1 receptors. Increases in ADK increase neuronal excitability, whereas decreases in ADK render the brain resistant to seizures and injury. Importantly, ADK was found to be overexpressed and associated with astrogliosis and spontaneous seizures in rodent models of epilepsy, as well as in human specimen resected from patients with hippocampal sclerosis and temporal lobe epilepsy. Several lines of evidence indicate that overexpression of astroglial ADK and adenosine deficiency are pathological hallmarks of the epileptic brain. Consequently, adenosine augmentation therapies constitute a powerful approach for seizure prevention, which is effective in models of epilepsy that are resistant to conventional antiepileptic drugs. The adenosine kinase hypothesis of epileptogenesis suggests that adenosine dysfunction in epilepsy undergoes a biphasic response: An acute surge of adenosine that can be triggered by any type of injury might contribute to the development of astrogliosis via adenosine receptor –dependent and –independent mechanisms. Astrogliosis in turn is associated with overexpression of ADK, which was shown to be sufficient to trigger spontaneous recurrent electrographic seizures. Thus, ADK emerges as a promising target for the prediction and prevention of epilepsy.

Boison, Detlev

2011-01-01

390

Biliary Tract Disorders, Gallbladder Disorders, and Gallstone Pancreatitis  

MedlinePLUS

... may be used to control or prevent infection. Sphincter of Oddi Dysfunction (Biliary Dyskinesia: Post-Cholecystectomy Syndrome) Overview What is sphincter of Oddi dysfunction? Sphincter of Oddi Dysfunction (SOD) is a ...

391

Normal lower esophageal sphincter pressure and length does not impact outcome after laparoscopic Nissen fundoplication.  

PubMed

Intuitively, a manometrically normal lower esophageal sphincter (LES) will promote dysphagia after laparoscopic Nissen fundoplication. This study was undertaken to compare outcomes after laparoscopic Nissen fundoplication for patients who had normal and manometrically inadequate LES preoperatively. Before fundoplication, the length and resting pressures of LES were determined manometrically in 59 patients with documented gastroesophageal reflux disease (GERD). Twenty-nine patients had a manometrically normal LES, with resting pressures >10 mm Hg and length >2 cm. Thirty patients had resting pressures of < or =10 mm Hg and length of < or =2 cm. Before and after fundoplication, patients graded the frequency and severity of symptoms of GERD utilizing a Likert scale (0 = never/not bothersome to 10 = always/very bothersome). DeMeester scores and symptom scores before and after fundoplication were compared. Before fundoplication, the manometric character of the LES did not impact the elevation of DeMeester scores or the frequency/severity of reflux symptoms. All symptoms improved significantly with fundoplication independent of LES pressure/length. Prefundoplication, manometric character of the LES did not impact the frequency or severity of reflux symptoms after fundoplication. Preoperative manometric character of the LES does not impact the presentation of GERD or the outcome after fundoplication. Symptoms globally and significantly improve after fundoplication, independent of manometric LES character. Normal LES manometry does not impact outcome and, specifically, does not promote dysphagia, after laparoscopic Nissen fundoplication. PMID:17436051

Cowgill, Sarah M; Bloomston, Mark; Al-Saadi, Sam; Villadolid, Desiree; Rosemurgy, Alexander S

2007-06-01

392

[Significance of nontraumatic anal sphincter relaxation for the success of plastic and miniinvasive interventions in coloproctology].  

PubMed

The investigation objective was to estimate the role of nontraumatic anal sphincter (AS) stretching, as a leading factor of success in minimally invasive and/or plastic proctological interventions. One-centre randomized investigation was performed in 83 patients: In 22 of them the AS fissura was revealed (in 16), suprasphincteric fistula (in 3) and coexistent rectocele 2-3 Ap (according to POP-Q classification) with thinning of the AS anterior segment, the degree III hemorrhoids and anterior AS fissure presence. Ninety units of botulotoxin preparation (Disport) were injected between internal and external AS portions 5-15 days preoperatively. The treatment results without botulotoxin injection were compared retrospectively. After botulotoxin injection performance the AS spasm elimination was noted, leading to the pain subsiding promotion before and postoperatively in all the patients observed. The spasm elimination have permitted to escape the anal high fistula recurrence as a result of the mucosal flap shift after intraluminal closure of the fistula or because of the fistula intermuscular electrowelding "suture" rupture, also have guaranteed the plastic sutures on AS, even while the stage II-III rectocele presence, not depending of performance of its simultant surgica correction. PMID:23718024

Podpriatov, S S; Korchak, V P; Ivanenko, S V; Stupak, M I; Zubariev, O V; Ivakha, V V; Sydorenko, O V; Shtaier, A A; Perekhrest, O V; Shchepetov, V V; Rostunov, V K; Bryzhatiuk, S V; Kozlov, V V

2013-03-01

393

Feedback control of TET system with variable coupling coefficients for a novel artificial anal sphincter.  

PubMed

For treating severe faecal incontinence, the authors developed an intelligent artificial anal sphincter system (AASS) equipped with a feedback sensor that utilized a transcutaneous energy transfer system (TETS). To deliver the correct amount of power (i.e. to match the load demand under variable coupling conditions caused by changes in positioning between the coils due to fitting and changes in posture), a regulating method to stabilize output voltage with a closed loop variable-frequency controller was developed in this paper. The method via which the voltage gain characteristics of a voltage-fed series-tuned TETS were derived is also described. The theoretical analysis was verified by the results of the experiment. A numerical analysis method was used as a control rule with respect to the relationship between operating frequency and output voltage. To validate the feedback control rules, a prototype of the TET charging system was constructed, and its performance was validated with the coupling variation between 0.12-0.42. The results show that the output voltage of the secondary side can be maintained at a constant 7?V across the whole coupling coefficient range, with a switching frequency regulation range of 271.4-320.5 kHz, and the proposed controller has reached a maximal end-to-end power efficiency of 67.5% at 1 W. PMID:24400997

Ke, L; Yan, G; Yan, S; Wang, Z; Liu, Z

2014-03-01

394

The effects of atropine or benzilonium on pelvic pouch and anal sphincter functions.  

PubMed

Anticholinergic drugs are used on an empirical basis for treatment of functional disturbances after restorative proctocolectomy, but their mode of action on ileal pouch performance is mainly unknown. We studied the acute effects of atropine or benzilonium on pouch characteristics and anal sphincter function in 20 patients with a pelvic pouch. Pouch volume was increased by 27% by atropine at distension with 20 cm H2O (p less than 0.01). Benzilonium tended to have a similar effect, but the changes did not reach statistical significance (p = 0.06). Pouch contractility, as reflected by volume fluctuations and pressure changes during distension, was almost abolished by both drugs. Sensory thresholds for sense of filling and, particularly, urge were raised. Resting anal pressure was slightly lowered, whereas no significant effect was found on maximal squeeze pressure. In conclusion, anticholinergics appear to have specific properties of action on small-intestinal reservoirs, constituting possible explanations for the empirically observed beneficial effects of anticholinergic treatment of functional disturbances after restorative proctocolectomy. PMID:1871549

Hallgren, T; Fasth, S; Delbro, D; Nordgren, S; Oresland, T; Hultén, L

1991-05-01

395

Purse-string morphology of external anal sphincter revealed by novel imaging techniques.  

PubMed

The external anal sphincter (EAS) may be injured in 25-35% of women during the first and subsequent vaginal childbirths and is likely the most common cause of anal incontinence. Since its first description almost 300 years ago, the EAS was believed to be a circular or a "donut-shaped" structure. Using three-dimensional transperineal ultrasound imaging, MRI, diffusion tensor imaging, and muscle fiber tracking, we delineated various components of the EAS and their muscle fiber directions. These novel imaging techniques suggest "purse-string" morphology, with "EAS muscles" crossing contralaterally in the perineal body to the contralateral transverse perineal (TP) and bulbospongiosus (BS) muscles, thus attaching the EAS to the pubic rami. Spin-tag MRI demonstrated purse-string action of the EAS muscle. Electromyography of TP/BS and EAS muscles revealed their simultaneous contraction and relaxation. Lidocaine injection into the TP/BS muscle significantly reduced anal canal pressure. These studies support purse-string morphology of the EAS to constrict/close the anal canal opening. Our findings have implications for the effect of episiotomy on anal closure function and the currently used surgical technique (overlapping sphincteroplasty) for EAS reconstructive surgery to treat anal incontinence. PMID:24458022

Mittal, Ravinder K; Bhargava, Valmik; Sheean, Geoff; Ledgerwood, Melissa; Sinha, Shantanu

2014-03-01

396

Surgical treatment of tumors of the distal rectum with sphincter preservation.  

PubMed Central

One hundred one patients with villous adenoma or invasive carcinoma of the distal rectum treated with local excision or coloanal anastomosis were studied. Twenty-three (45%) of the 51 patients with villous adenomas had transanal excision, another 23 (45%) had a posterior proctotomy, and five (10%) had a coloanal anastomosis. Only two patients with a villous adenoma developed a recurrence requiring repeat local excision. Fifteen (30%) of the 50 patients with invasive cancer were treated by transanal excision. All had tumors confined to the submucosa or superficial muscularis. Eighteen (85%) of 21 patients having posterior proctotomy also had tumors with similar depth of invasion. Six (43%) of the 14 patients having coloanal anastomosis had Dukes' B tumors, six (43%) were Dukes' C, and another two (14%) underwent palliative resection. The overall actuarial 5-year survival was 77%. Only four patients treated by transanal excision or posterior proctotomy died of metastatic disease. In the coloanal group, two of 12 patients undergoing curative resection died of recurrent cancer, and another has a pelvic recurrence. Villous adenomas of the distal rectum and selected carcinomas may be treated with local excision and coloanal anastomosis with preservation of sphincter function with good results.

Heimann, T M; Oh, C; Steinhagen, R M; Greenstein, A J; Perez, C; Aufses, A H

1992-01-01

397

PHARYNGEAL SWALLOWING: DEFINING PHARYNGEAL AND UPPER ESOPHAGEAL SPHINCTER RELATIONSHIPS IN HUMAN NEONATES  

PubMed Central

Objective To test the hypothesis that the sensory-motor characteristics of the reflexes evoked upon stimulation with air and water infusions differ, we studied the effect of pharyngeal stimulation on the pharyngeal-upper esophageal sphincter (UES) interactions in healthy neonates Study design Pharyngo-UES-esophageal manometry was recorded in 10 neonates at 39 ± 4 wk postmenstrual age. Pharyngeal infusions (n=155) of air (0.1–2.0 ml) and sterile water (0.1–0.5 ml) were given. Two types of reflexes were recognized: Pharyngeal reflexive swallowing (PRS) and pharyngo-UES-contractile reflex (PUCR). Frequency occurrence, distribution of reflexes, threshold volume, response time, and stimulus-response relationship were evaluated. Results The reflex response rate for air was 30% and was 76% for water (P<0.001). The frequency occurrence of PRS was greater than PUCR with air and water (P<0.05), although the stimulation thresholds and response latency were similar. Graded volumes of water but not air resulted in an increased frequency of PRS (P<0.01). Conclusions PRS is the most frequent response, and characteristics of the reflexes are distinct between air vs. water stimuli. These methods have implications for the evaluation of swallowing in infants.

Jadcherla, Sudarshan Rao; Gupta, Alankar; Stoner, Erin; Fernandez, Soledad; Shaker, Reza

2008-01-01

398

Radial asymmetry of the upper oesophageal sphincter pressure profile: fact or artefact.  

PubMed

Radial asymmetry of the upper oesophageal sphincter high-pressure zone (UESHPZ) is an accepted notion based on manometric studies. Our aim was to evaluate the effect of the catheter diameter and configuration on the resting pressure profile of the UES. We studied 14 young (30 +/- 2 years) and 14 healthy elderly volunteers (77 +/- 2 years) using the station pull-through technique. We used a specially designed water perfused manometric assembly that incorporated a proximal round cross-section (4.8 mm) and a distal flat cross-section (4.8 x 1.2 mm). Anterior and posterior manometric sites on the round catheter measured significantly higher pressure values than did the sites oriented laterally at the same level (P < 0.001) in both young and elderly. In contrast, the flat-shaped catheter measured statistically indistinguishable pressures from all four orientations in both age groups. In both young and elderly the anterio-posterior, but not lateral pressures by the round catheter were significantly higher (P < 0.001) than those of the flat catheter. An exaggerated anteriorly and posteriorly oriented pressure may be recorded compared with lateral pressures depending on the diameter and non-conforming shape of the recording catheter with respect to the UES producing the appearance of radial asymmetry in the UESHPZ. PMID:16700720

Bardan, E; Kern, M; Torrico, S; Arndorfer, R C; Massey, B T; Shaker, R

2006-06-01

399

Tulane experience with management of urinary incontinence after placement of an artificial urinary sphincter.  

PubMed

Persistent urinary incontinence following placement of an artificial urinary sphincter (AUS) presents a challenging diagnostic problem. This report reviews 30 cases (27 males and 3 females) involving urinary incontinence following AUS placement. The mean age of the patients was 64.4 years (range, 10-79 years). Physical examination demonstrated evidence or suspicion of infection or erosion in 7 patients, and subsequent cystoscopic examination revealed erosion caused by the cuff in 6 of these 7 cases. The remaining 23 patients were evaluated by videofluorourodynamics (VFUD) to ascertain the cause of incontinence. VFUD demonstrated detrusor instability in 9 patients (39%), low detrusor compliance in 3 patients (13%), and poor detrusor contractility in 1 patient (4.4%). Bladder-outlet obstruction was diagnosed in 2 patients (8.8%)-1 with bladder-neck contracture and 1 with ureteral stricture. Altogether, 2 (8.8%) cases of tissue atrophy were diagnosed with low urethral closing pressure at the cuff. In all, 1 patient (4.4%) was diagnosed as having a vesicovaginal fistula, 1 (4.4%) had a tubing kink, and 4 (17%) had leaking devices diagnosed during VFUD by cycling of the device. Of the 23 patients, 21 (91%) demonstrably improve or became fully continent after appropriate treatment had been initiated. A review of this study suggests that the majority of incontinent patients after AUS implantation can be managed successfully, provided that a systematic diagnostic approach is followed and appropriate treatment is initiated. PMID:7881472

Ghoniem, G M; Lapeyrolerie, J; Sood, O P; Thomas, R

1994-01-01

400

Mitochondrial Dysfunction and Bipolar Disorder  

Microsoft Academic Search

\\u000a The mitochondrial dysfunction hypothesis was proposed to integrate various findings in bipolar disorder (BPD). This hypothesis\\u000a is supported by possible roles of maternal inheritance, comorbidity with mitochondrial diseases, the mechanism of action of\\u000a mood stabilizers, magnetic resonance spectroscopy, mitochondrial DNA mutations, gene expression analysis, and phenotypes of\\u000a animal models. Mitochondrial dysfunction is not specific to BPD but is common to

Tadafumi Kato

401

Dysfunctional anger and sexual violence.  

PubMed

Sexual offenses with or without aggression attract attention from the popular media and the scientific community. Empirical research suggests a relationship between anger and sexual violence. This article describes the key themes of dysfunctional anger and sexual violence, and how dysfunctional anger relates to sexual fantasies, sexual offending, and sexual recidivism. The implications of the findings for clinical practice and future research are discussed. PMID:24877709

Ahmed, A G

2014-06-01

402

Gene Therapy for Erectile Dysfunction  

Microsoft Academic Search

Our current understanding of the underlying mechanisms of erectile dysfunction suggests that gene therapy will become a therapeutic\\u000a treatment in the near future. Over the past decade, erectile dysfunction has been ameliorated in animal models using viral-and\\u000a plasmid-based vectors. Genes that stimulate smooth muscle cell relaxation, such as neuronal, inducible, and endothelial nitric\\u000a oxide synthase, or that inhibit smooth muscle

Thomas R. Magee; Jacob Rajfer; Nestor F. Gonzalez-Cadavid

403

Metabolic syndrome and endothelial dysfunction  

Microsoft Academic Search

The incidence of metabolic syndrome is rapidly increasing in the United States. Metabolic syndrome is associated with increased\\u000a cardiovascular morbidity and mortality, and endothelial dysfunction is an early pathogenetic event in the metabolic syndrome.\\u000a Endothelial dysfunction of either the coronary, the peripheral, or the cerebral vasculature is a predictor of vascular events\\u000a and appears to be a marker of uncontrolled

Alessia Fornoni; Leopoldo Raij

2005-01-01

404

[The crural diaphragm belongs to the pharyngeo-cardial continence organ (PET-CT and impedance measurements on the stretch sphincter and its fixation in the hiatus oesophageus of the diaphragm)].  

PubMed

This paper provides evidence that pharyngeo-cardial propulsion in the oesophagus follows similar principles as translocation of luminal contents in other locations in the body. In brief, the following statements are discussed in the paper: 1. Only animals with a lung-based respiratory system have an oesophagus. 2. Its bulky muscular wall is made up of the elastic fibres which ensure that the oesophagus stays elastic during an entire lifetime. 3. While short-segment ring sphincter systems exist in several locations in the body, the lower oesophageal sphincter is maximally elongated. This configuration helps with the propulsion of luminal contents in addition to this sphincter's opening and occlusive functions. 4. The musculature of the diaphragm is genetically related to the cervical muscles. The crural portion of the diaphragm works in coordination with the lower oesophageal stretch sphincter. 5. Gastro-oesophageal reflux disease is fairly common. In patients with this disorder, the oesophagus is too short and the stretch sphincter remains patent for abnormal periods of time. 6. When the stretch sphincter is surgically retightened by transposition of the oesophageal cardia into the abdomen, a proper function of the regulatory lower oesophageal stretch sphincter can be restored. 7.-9. All fundoplication procedures place the lower oesophageal sphincter under stretch, squeeze and create an oesophageal wrap out of gastric fundus tissue. X-ray images confirm in many patients undergoing fundoplication that the anatomic stretch sphincter already starts above and proximally to the plicated cuff. PMID:22933012

Stelzner, F; von Mallek, D

2012-08-01

405

Obesity, inflammation and endothelial dysfunction.  

PubMed

Cardiovascular disease is the leading cause of morbidity and mortality in obese individuals. Obesity dramatically increases the risk of development of metabolic and cardiovascular disease. This risk appears to originate from disruption in adipose tissue function leading to a chronic inflammatory state and to dysregulation of the endocrine and paracrine actions of adipocyte-derived factors. These, in turn, impair vascular homeostasis and lead to endothelial dysfunction. An altered endothelial cell phenotype and endothelial dysfunction are common among all obesity-related complications. A crucial aspect of endothelial dysfunction is reduced nitric oxide (NO) bioavailability. A systemic pro-inflammatory state in combination with hyperglycemia, insulin resistance, oxidative stress and activation of the renin angiotensin system are systemic disturbances in obese individuals that contribute independently and synergistically to decreasing NO bioavailability. On the other hand, pro-inflammatory cytokines are locally produced by perivascular fat and act through a paracrine mechanism to independently contribute to endothelial dysfunction and smooth muscle cell dysfunction and to the pathogenesis of vascular disease in obese individuals. The promising discovery that obesity-induced vascular dysfunction is, at least in part, reversible, with weight loss strategies and drugs that promote vascular health, has not been sufficiently proved to prevent the cardiovascular complication of obesity on a large scale. In this review we discuss the pathophysiological mechanisms underlying inflammation and vascular damage in obese patients. PMID:25001649

Iantorno, M; Campia, U; Di Daniele, N; Nistico, S; Forleo, G B; Cardillo, C; Tesauro, M

2014-01-01

406

Management of erectile dysfunction.  

PubMed

Erectile dysfunction (ED) is the most common sexual problem in men. The incidence increases with age and affects up to one third of men throughout their lives. It causes a substantial negative impact on intimate relationships, quality of life, and self-esteem. History and physical examination are sufficient to make a diagnosis of ED in most cases, because there is no preferred, first-line diagnostic test. Initial diagnostic workup should usually be limited to a fasting serum glucose level and lipid panel, thyroid-stimulating hormone test, and morning total testosterone level. First-line therapy for ED consists of lifestyle changes, modifying drug therapy that may cause ED, and pharmacotherapy with phosphodiesterase type 5 inhibitors. Obesity, sedentary lifestyle, and smoking greatly increase the risk of ED. Phosphodiesterase type 5 inhibitors are the most effective oral drugs for treatment of ED, including ED associated with diabetes mellitus, spinal cord injury, and antidepressants. Intraurethral and intracavernosal alprostadil, vacuum pump devices, and surgically implanted penile prostheses are alternative therapeutic options when phosphodiesterase type 5 inhibitors fail. Testosterone supplementation in men with hypogonadism improves ED and libido, but requires interval monitoring of hemoglobin, serum transaminase, and prostate-specific antigen levels because of an increased risk of prostate adenocarcinoma. Cognitive behavior therapy and therapy aimed at improving relationships may help to improve ED. Screening for cardiovascular risk factors should be considered in men with ED, because symptoms of ED present on average three years earlier than symptoms of coronary artery disease. Men with ED are at increased risk of coronary, cerebrovascular, and peripheral vascular diseases. PMID:20112889

Heidelbaugh, Joel J

2010-02-01

407

The impact of an intervention programme employing a hands-on technique to reduce the incidence of anal sphincter tears: interrupted time-series reanalysis  

PubMed Central

Objective To re-evaluate previously published findings from an uncontrolled before–after evaluation of an intervention programme to reduce the incidence of anal sphincter tears. A key component of the programme was the use of a hands-on technique where the birth attendant presses the neonate's head during the final stage of delivery while simultaneously supporting the woman's perineum with the other hand. Design Interrupted time-series analysis using segmented regression modelling. Setting Obstetric departments of five Norwegian hospitals. Participants All women giving births vaginally in the study hospitals, 2002–2008. Methods The main data source was the Medical Birth Registry of Norway. We estimated the change in incidence of anal sphincter tears before and after implementation of the intervention in the five intervention hospitals, taking into account the trends in incidence before and after implementation. Main outcome measures Incidence of anal sphincter tears and episiotomies. Results There were 75?543 registered births at the five included hospitals. We found a 2% absolute reduction in incidence of anal sphincter tears associated with the hospital intervention programme, representing almost a halving in the number of women experiencing serious anal sphincter tears. This is a substantially smaller estimate than previously reported. However, it does represent a highly significant decrease in anal sphincter injuries. The programme was also associated with a significant increase in episiotomies. Conclusions The intervention programme was associated with a significant reduction in the incidence of obstetric anal sphincter tears. Still, the findings should be interpreted with caution as they seem to contradict the findings from randomised controlled studies of similar interventions.

Fretheim, Atle; Odgaard-Jensen, Jan; R?ttingen, John-Arne; Reinar, Liv Merete; Vangen, Siri; Tanbo, Tom

2013-01-01

408

Erectile dysfunction in patients with cardiovascular disease  

PubMed Central

Erectile dysfunction is a highly prevalent disease, especially in cardiovascular-compromised men. Many of the well-established risk factors for cardiovascular disease are also risk factors for erectile dysfunction. A correlation between erectile dysfunction and endothelial dysfunction is well established. It is postulated that erectile dysfunction with an arteriovascular aetiology can predate and be an indicator of potential coronary artery disease. In this paper we will attempt to increase awareness among cardiologists for the predictive value of erectile dysfunction for future cardiovascular disease in order to optimise cardiovascular risk management. The treatment of erectile dysfunction and cardiovascular interactions is also discussed in detail. ImagesFigure 1AFigure 1B

Ophuis, A.J.M. Oude; Nijeholt, A.A.B. Lycklama a

2006-01-01

409

Bladder dysfunction changes from underactive to overactive after experimental traumatic brain injury  

PubMed Central

Although bladder dysfunction is common after traumatic brain injury (TBI), few studies have investigated resultant bladder changes and the detailed relationship between TBI and bladder dysfunction. The goal of this study was to characterize the effects of TBI on bladder function in an animal model. Fluid-percussion injury was used to create an animal model with moderate TBI. Female Sprague-Dawley rats underwent TBI, sham TBI or were not manipulated (naïve). All rats underwent filling cystometry while bladder pressure and external urethral sphincter electromyograms were simultaneously recorded 1 day, 1 week, 2 weeks, and 1 month after injury. One day after injury, 70% of the animals in the TBI group and 29% of the animals in the sham TBI group showed no bursting activity during urination. Compared to naïve rats, bladder function was mainly altered 1 day and 1 week after sham TBI, suggesting the craniotomy procedure affected bladder function mostly in a temporary manner. Compared to either naïve or sham TBI, bladder weight was significantly increased 1 month after TBI and collagen in the bladder wall was increased. Bladder function in the TBI group went from atonic 1 day post-TBI to overactive 1 month post-TBI, suggesting that TBI significantly affected bladder function.

Jiang, Hai-Hong; Kokiko-Cochran, Olga N.; Li, Kevin; Balog, Brian; Lin, Ching-Yi; Damaser, Margot S.; Lin, Vernon; Cheng, Julian Yaoan; Lee, Yu-Shang

2012-01-01

410

Endothelial dysfunction in morbid obesity.  

PubMed

Morbid obesity is a chronic multifunctional disease characterized by an accumulation of fat. Epidemiological studies have shown that obesity is associated with cardiovascular and metabolic disorders. Endothelial dysfunction, as defined by an imbalance between relaxing and contractile endothelial factors, plays a central role in the pathogenesis of these cardiometabolic diseases. Diminished bioavailability of nitric oxide (NO) contributes to endothelial dysfunction and impairs endothelium- dependent vasodilatation. But this is not the only mechanism that drives to endothelial dysfunction. Obesity has been associated with a chronic inflammatory process, atherosclerosis, and oxidative stress. Moreover levels of asymmetrical dimethyl-L-arginine (ADMA), an endogenous inhibitor of endothelial nitric oxide synthase (eNOS), are elevated in obesity. On the other hand, increasing prostanoid-dependent vasoconstriction and decreasing vasodilator prostanoids also lead to endothelial dysfunction in obesity. Other mechanisms related to endothelin-1 (ET-1) or endothelium derived hyperpolarizing factor (EDHF) have been proposed. Bariatric surgery (BS) is a safe and effective means to achieve significant weight loss, but its use is limited only to patients with severe obesity including morbid obesity. BS also proved efficient in endothelial dysfunction reduction improving cardiovascular and metabolic comorbidities associated with morbid obesity such as diabetes, coronary artery disease, nonalcoholic fatty liver disease and cancer. This review will provide a brief overview of the mechanisms that link obesity with endothelial dysfunction, and how weight loss is a cornerstone treatment for cardiovascular comorbidities obesity-related. A better understanding of the mechanisms of obesity-induced endothelial dysfunction may help develop new therapeutic strategies to reduce cardiovascular morbidity and mortality. PMID:23448493

Mauricio, Maria Dolores; Aldasoro, Martin; Ortega, Joaquin; Vila, José María

2013-01-01

411

Epidemiological Features of Infantile Hypertrophic Pyloric Stenosis in Taiwanese Children: A Nation-Wide Analysis of Cases during 1997-2007  

PubMed Central

Objective To describe the epidemiological characteristics of infantile hypertrophic pyloric stenosis (IHPS) in ethnic Chinese children. Materials and Methods We reviewed the National Health Insurance claims database and analyzed data from children less than one year of age who had been diagnosed with IHPS (ICD-9-CM 750.5) and had undergone pyloromyotomy (ICD-9-CM 43.3). We analyzed the incidence, gender, age at diagnosis, length of hospital stay, seasonal variation and cost of IHPS from data collected between January 1997 and December 2007. Results A total of 1,077 infants met inclusion criteria, including 889 boys and 188 girls. The annual incidence of IHPS ranged from 0.30 to 0.47 per 1,000 live births with a mean incidence of 0.39 per 1,000 live births. Between 2002 and 2007, the incidence showed a declining trend (P?=?0.025) with coincidentally increasing trends for both exclusive breastfeeding (P?=?0.014) and breastfeeding plus bottle feeding (P?=?0.004). The male-to-female rate ratio was dynamic and increased from 3.03 during the first two weeks of life to 8.94 during the 8th through 10thweeks of life. The overall male-to-female rate ratio was 4.30. The mean age at diagnosis was 43.1±2.4 days. After analyzing the months of birth and hospital admission, no seasonal variation associated with IHPS was detected. The mean length of hospital stay was 8.28±7.10 days. Conclusions The incidence of IHPS in Taiwan, a country with a majority ethnic Chinese population, was lower than observed incidences in Caucasian populations living in Western countries. Breastfeeding campaigns and low maternal smoking rates may contribute to the lower incidence of IHPS in Taiwan. However, additional studies with longer follow-up periods are needed.

Leong, Mee-Mee; Chen, Solomon Chih-Cheng; Hsieh, Chih-Sung; Chin, Yow-Yue; Tok, Teck-Siang; Wu, Shu-Fen; Peng, Ching-Tien; Chen, An-Chyi

2011-01-01

412

From endothelial dysfunction to atherosclerosis.  

PubMed

It has recently emerged that endothelial dysfunction is an early step in the development of atherosclerosis and is mainly characterised by a reduction in the bioavailability of nitric oxide. All of the traditional cardiovascular (CV) risk factors (dyslipidemia, arterial hypertension, hyperglycemia and diabetes) are associated with endothelial dysfunction, and oxidised low-density lipoproteins, the renin-angiotensin axis and insulin resistance play important roles in the pathogenesis of impaired endothelial function. The increased expression of adhesion molecules and pro-inflammatory cytokines leads to abnormal endothelium-dependent vasodilation which could be investigated using vasoreactivity tests such as flow-mediated dilation in the brachial artery. Recently, new evidences showed that the immune system plays an important role in the pathogenesis of endothelial dysfunction and atherosclerosis with a particular regard towards autoimmunity. The high prevalence of the atherosclerotic process in systemic autoimmune diseases supports the hypothesis of the immune pathogenesis. Evaluating coronary microvascular dysfunction by means of transthoracic echocardiography with non-invasive coronary flow reserve assessment is particularly interesting as it could detect preclinical impairment of coronary microvascular function. The discovery that the mechanisms responsible for endothelial damage have a genetic basis could improve the approach to CV diseases. This review summarises the most important aspects of the pathogenesis and development of endothelial dysfunction, with particular attention to the role of traditional CV risk factors, the usefulness of vasoreactivity tests, and the future perspectives opened by genetic studies. PMID:20678595

Sitia, S; Tomasoni, L; Atzeni, F; Ambrosio, G; Cordiano, C; Catapano, A; Tramontana, S; Perticone, F; Naccarato, P; Camici, P; Picano, E; Cortigiani, L; Bevilacqua, M; Milazzo, L; Cusi, D; Barlassina, C; Sarzi-Puttini, P; Turiel, M

2010-10-01

413

Unrecognised ventricular dysfunction in COPD.  

PubMed

While both chronic congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) impose a substantial disease burden and share aetiological and epidemiological associations, they have largely been studied separately. The aim of our study was to assess the prevalence and the prognostic implications of the coexistence of left ventricular dysfunction in COPD patients and airway obstruction in CHF patients. We used a prospective cohort study including stable ? 60-yr-old patients with echocardiographically confirmed CHF (n=201) and stable ? 60-yr-old patients with clinically and spirometry-confirmed COPD (n=218). All CHF patients underwent routine spirometry, and all COPD patients underwent routine echocardiographic assessment and B-type natriuretic peptide (BNP) measurement. Patients were followed for 2 yrs. The prevalence of airway obstruction among CHF patients was 37.3% and the prevalence of ventricular dysfunction among COPD patients was 17%. The presence of ventricular dysfunction in patients with COPD tended to increase the risk of mortality during follow-up (hazard ratio 2.34, 95% CI 0.99-5.54; p=0.053). The presence of airway obstruction in patients with CHF did not influence survival. CHF and COPD frequently coexist, and ventricular dysfunction worsens survival in patients with COPD. Considering the high prevalence and the prognostic implications of ventricular dysfunction, routine assessment with either BNP or echocardiogram should be considered in COPD patients. PMID:21700606

Macchia, A; Rodriguez Moncalvo, J J; Kleinert, M; Comignani, P D; Gimeno, G; Arakaki, D; Laffaye, N; Fuselli, J J; Massolin, H P; Gambarte, J; Romero, M; Tognoni, G

2012-01-01

414

Quality of life after laparoscopic vs open sphincter-preserving resection for rectal cancer  

PubMed Central

AIM: To compare quality of life (QoL) outcomes in Chinese patients after curative laparoscopic vs open surgery for rectal cancer. METHODS: Eligible Chinese patients with rectal cancer undergoing curative laparoscopic or open sphincter-preserving resection between July 2006 and July 2008 were enrolled in this prospective study. The QoL outcomes were assessed longitudinally using the validated Chinese versions of the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-CR38 questionnaires before surgery and at 4, 8, and 12 mo after surgery. The QoL scores at the different time points were compared between the laparoscopic and open groups. A higher score on a functional scale indicated better functioning, whereas a higher score on a symptom scale indicated a higher degree of symptoms. RESULTS: Seventy-four patients (49 laparoscopic and 25 open) were enrolled. The two groups of patients were comparable in terms of sociodemographic data, types of surgery, tumor staging, and baseline mean QoL scores. There was no significant decrease from baseline in global QoL for the laparoscopic group at different time points, whereas the global QoL was worse compared to baseline beginning at 4 mo but returned to baseline by 12 mo for the open group (P = 0.019, Friedman test). Compared to the open group, the laparoscopic group had significantly better physical (89.9 ± 1.4 vs 79.2 ± 3.7, P = 0.016), role (85.0 ± 3.4 vs 63.3 ± 6.9, P = 0.005), and cognitive (73.5 ± 3.4 vs 50.7 ± 6.2, P = 0.002) functioning at 8 mo, fewer micturition problems at 4-8 mo (4 mo: 32.3 ± 4.7 vs 54.7 ± 7.1, P = 0.011; 8 mo: 22.8 ± 4.0 vs 40.7 ± 6.9, P = 0.020), and fewer male sexual problems from 8 mo onward (20.0 ± 8.5 vs 76.7 ± 14.5, P = 0.013). At 12 mo after surgery, no significant differences were observed in any functional or symptom scale between the two groups, with the exception of male sexual problems, which remained worse in the open group (29.2 ± 11.3 vs 80.0 ± 9.7, P = 0.026). CONCLUSION: Laparoscopic sphincter-preserving resection for rectal cancer is associated with better preservation of QoL and fewer male sexual problems when compared with open surgery in Chinese patients. These findings, however, should be interpreted with caution because of the small sample size of the study.

Ng, Simon Siu-Man; Leung, Wing-Wa; Wong, Cherry Yee-Ni; Hon, Sophie Sok-Fei; Mak, Tony Wing-Chung; Ngo, Dennis Kwok-Yu; Lee, Janet Fung-Yee

2013-01-01

415

Brainstem sites controlling the lower esophageal sphincter and crural diaphragm in the ferret: a neuroanatomical study.  

PubMed

The lower esophageal sphincter (LES) and the crural diaphragm (CD) surrounding the esophagogastric junction are key components of the gastroesophageal reflex mechanism, which engages the vago-vagal brainstem circuitry. Although both components work in conjunction to prevent gastroesophageal reflux, little is known about the brain area(s) where this integration takes place. The aims of this study were to: (1) trace the brainstem circuitry associated with the CD and the LES, and (2) determine possible sites of convergence. Experiments were done in adult male ferrets. Under isoflurane anesthesia, recombinant strains of the transneuronal pseudorabies virus (PRV-151 or PRV-Bablu) or the monosynaptic retrograde tracer cholera toxin beta-subunit (CTb) were injected into either the CD or the LES. Following a survival period of 5-7 days, animals were euthanized, perfused and their brains removed for dual-labeling immunofluorescence processing. In animals injected with recombinants of PRV into the CD and the LES, distinct labeling was found in various brainstem nuclei including: area postrema, DMV, nucleus tractus solitarius (NTS), medial reticular formation (MRF) and nucleus ambiguous (NA). Double-labeled cells were only evident in the DMV, NTS and MRF. Injections of CTb into the CD or the LES resulted in retrograde labeling only in the DMV. These findings demonstrate the presence of a direct projection from the DMV to the CD. They further suggest that the neuronal connections responsible for CD or LES function are contained in circuitries that, though largely independent, may converge at the level of DMV, NTS and MRF. PMID:18986853

Niedringhaus, Mark; Jackson, Patrick G; Pearson, Rebecca; Shi, Min; Dretchen, Kenneth; Gillis, Richard A; Sahibzada, Niaz

2008-12-15

416

Electrical activation of common bile duct nerves modulates sphincter of Oddi motility in the Australian possum  

PubMed Central

Background: Sphincter of Oddi (SO) motility is regulated by extrinsic and intrinsic nerves. The existence of neural circuits between the SO and the proximal extrahepatic biliary tree has been reported, but they are poorly understood. Using electrical field stimulation (EFS), we determined if a neural circuit exists between the common bile duct (CBD) and the SO in anaesthetized Australian brush-tailed possums. Methods: The gallbladder, cystic duct or CBD were subjected to EFS with a stimulating electrode. Spontaneous SO phasic waves were measured by manometry. Results: EFS at sites on the distal CBD (12–20 mm proximal to the SO), but less commonly at more proximal CBD, evoked a variety of responses consisting of an excitatory and/or inhibitory phase. Bi-phasic responses consisting of an excitation followed by inhibition were the most common. Tri-phasic responses were also observed as well as excitation or inhibition only. These evoked responses were blocked by topical application of local anaesthetic to the distal CBD or transection of the CBD. EFS at sites on the gallbladder body, neck or cystic duct did not consistently evoke an SO response. Pretreatment with atropine or guanethidine reduced the magnitude of the evoked response by about 50% (p<0.05), pretreatment with hexamethonium had no consistent effect and pretreatment with a nitric oxide synthase inhibitor increased the response. Discussion: A neural circuit(s) between the SO and the distal CBD modulates SO motility. Damage to this area of the CBD during bile duct exploration surgery could adversely affect SO motility.

Sonoda, Y.; Takahata, S.; Jabar, F.; Schloithe, A. C.; Grivell, M. A.; Woods, C. M.; Simula, M. E.; Toouli, J.

2005-01-01

417

Pressure morphology of the relaxed lower esophageal sphincter: the formation and collapse of the phrenic ampulla  

PubMed Central

This study aimed to apply novel high-resolution manometry with eight-sector radial pressure resolution (3D-HRM technology) to resolve the deglutitive pressure morphology at the esophagogastric junction (EGJ) before, during, and after bolus transit. A hybrid HRM assembly, including a 9-cm-long 3D-HRM array, was used to record EGJ pressure morphology in 15 normal subjects. Concurrent videofluoroscopy was used to relate bolus movement to pressure morphology and EGJ anatomy, aided by an endoclip marking the squamocolumnar junction (SCJ). The contractile deceleration point (CDP) marked the time at which luminal clearance slowed to 1.1 cm/s and the location (4 cm proximal to the elevated SCJ) at which peristalsis terminated. The phrenic ampulla spanned from the CDP to the SCJ. The subsequent radial and axial collapse of the ampulla coincided with the reconstitution of the effaced and elongated lower esophageal sphincter (LES). Following ampullary emptying, the stretched LES (maximum length 4.0 cm) progressively collapsed to its baseline length of 1.9 cm (P < 0.001). The phrenic ampulla is a transient structure comprised of the stretched, effaced, and axially displaced LES that serves as a “yield zone” to facilitate bolus transfer to the stomach. During ampullary emptying, the LES circular muscle contracts, and longitudinal muscle shortens while that of the adjacent esophagus reelongates. The likely LES elongation with the formation of the ampulla and shortening to its native length after ampullary emptying suggest that reduction in the resting tone of the longitudinal muscle within the LES segment is a previously unrecognized component of LES relaxation.

Kwiatek, Monika A.; Nicodeme, Frederic; Pandolfino, John E.

2012-01-01

418

External Urethral Sphincter Motoneuron Properties in Adult Female Rats Studied In Vitro  

PubMed Central

The external urethral sphincter (EUS) muscle plays a crucial role in lower urinary tract function: its activation helps maintain continence, whereas its relaxation contributes to micturition. To determine how the intrinsic properties of its motoneurons contribute to its physiological function, we have obtained intracellular current-clamp recordings from 49 EUS motoneurons in acutely isolated spinal cord slices from adult female rats. In all, 45% of EUS motoneurons fired spontaneously and steadily (average rate = 12–27 pulses/s). EUS motoneurons were highly excitable, having lower rheobase, higher input resistance, and smaller threshold depolarization than those of rat hindlimb motoneurons recorded in vitro. Correlations between these properties and afterhyperpolarization half-decay time are consistent with EUS motoneurons having characteristics of both fast and slow motor unit types. EUS motoneurons with a slow-like spectrum of properties exhibited spontaneous firing more often than those with fast-like characteristics. During triangular current ramp-induced repetitive firing, recruitment typically occurred at lower current levels than those at derecruitment, although the opposite pattern occurred in 10% of EUS motoneurons. This percentage was likely underestimated due to firing rate adaptation. These findings are consistent with the presence of a basal level of persistent inward current (PIC) in at least some EUS motoneurons. The low EUS motoneuron current and voltage thresholds make them readily recruitable, rendering them well suited to their physiological role in continence. The expression of firing behaviors consistent with PIC activation in this highly reduced preparation raises the possibility that in the intact animal, PICs contribute to urinary function not only through neuromodulator-dependent but also through neuromodulator-independent mechanisms.

Tennissen, Ann M.; Liebschutz, Jennifer E.; Chen, Xiang Yang; Wolpaw, Jonathan R.

2010-01-01

419

Functional role of vasoactive intestinal polypeptide in inhibitory motor innervation in the mouse internal anal sphincter.  

PubMed

There is evidence that vasoactive intestinal polypeptide (VIP) participates in inhibitory neuromuscular transmission (NMT) in the internal anal sphincter (IAS). However, specific details concerning VIP-ergic NMT are limited, largely because of difficulties in selectively blocking other inhibitory neural pathways. The present study used the selective P2Y1 receptor antagonist MRS2500 (1 ?m) and the nitric oxide synthase inhibitor N(G)-nitro-l-arginine (l-NNA; 100 ?m) to block purinergic and nitrergic NMT to characterize non-purinergic, non-nitrergic (NNNP) inhibitory NMT and the role of VIP in this response. Nerves were stimulated with electrical field stimulation (0.1-20 Hz, 4-60 s) and the associated changes in contractile and electrical activity measured in non-adrenergic, non-cholinergic conditions in the IAS of wild-type and VIP(-/-) mice. Electrical field stimulation gave rise to frequency-dependent relaxation and hyperpolarization that was blocked by tetrodotoxin. Responses during brief trains of stimuli (4 s) were mediated by purinergic and nitrergic NMT. During longer stimulus trains, an NNNP relaxation and hyperpolarization developed slowly and persisted for several minutes beyond the end of the stimulus train. The NNNP NMT was abolished by VIP6-28 (30 ?m), absent in the VIP(-/-) mouse and mimicked by exogenous VIP (1-100 nm). Immunoreactivity for VIP was co-localized with neuronal nitric oxide synthase in varicose intramuscular fibres but was not detected in the VIP(-/-) mouse IAS. In conclusion, this study identified an ultraslow component of inhibitory NMT in the IAS mediated by VIP. In vivo, this pathway may be activated with larger rectal distensions, leading to a more prolonged period of anal relaxation. PMID:23339175

Keef, K D; Saxton, S N; McDowall, R A; Kaminski, R E; Duffy, A M; Cobine, C A

2013-03-15

420

Videofluoroscopic and Manometric Evaluation of Pharyngeal and Upper Esophageal Sphincter Function During Swallowing  

PubMed Central

Background/Aims The purpose of this study was to determine important manometric metrics for the analysis of pharyngeal and upper esophageal sphincter (UES) function and to investigate the effect of viscosity and other confounding factors on manometric results. Methods Manometric studies were performed on 26 asymptomatic volunteers (12 men and 14 women; age, 19–81 years). The manometric protocol included 5 water swallows (5 mL), 5 barium swallows (5 mL) and 5 yogurt swallows (5 mL). Evaluation of high-resolution manometry parameters including basal pressure of the UES, mesopharyngeal contractile integral (mesopharyngeal CI, mmHg · cm · sec), CI of the hypopharynx and UES (hypopharyngeal CI), relaxation interval of UES, median intrabolus pressure and nadir pressure at UES was performed using MATLAB. Results Mesopharyngeal CIs for barium and yogurt swallows were significantly lower than those for water swallows (both P < 0.05). Hypopharyngeal CIs for water swallows were significantly lower than those for barium swallows (P = 0.004), and median bolus pressure at UES for barium swallows was significantly higher than that for water and yogurt swallows (both P < 0.05). Furthermore, hypopharyngeal CI and median intrabolus pressure at UES were significantly related to age for 3 swallows (all P < 0.01 and P < 0.05, respectively). A significant negative correlation was also noted between nadir pressure at UES and age for water and yogurt swallows (all P < 0.05). Conclusions Manometric measurement of the pharynx and UES varies with respect to viscosity. Moreover, age could be a confounding variable in the interpretation of pharyngeal manometry.

Yoon, Kyung Jae; Park, Jung Ho; Park, Jung Hwan; Jung, Il Seok

2014-01-01

421

Axial stretch: A novel mechanism of the lower esophageal sphincter relaxation.  

PubMed

Swallow and esophageal distension-induced relaxations of the lower esophageal sphincter (LES) are associated with an orad movement of the LES because of a concurrent esophageal longitudinal muscle contraction. We hypothesized that the esophageal longitudinal muscle contraction induces a cranially directed mechanical stretch on the LES and therefore studied the effects of a mechanical stretch on the LES pressure. In adult opossums, a silicon tube was placed via mouth into the esophagus and laparotomy was performed. Two needles with silk sutures were passed, 90 degrees apart, through the esophageal walls and silicon tube, 2 cm above the LES. The tube was withdrawn, and one end of each of the four sutures was anchored to the esophageal wall and the other end exited through the mouth to exert graded cranially directed stretch on the LES by using pulley and weights. A cranially directed stretch caused LES relaxation, and with the cessation of stretch there was recovery of the LES pressure. The degree an d duration of LES relaxation increased with the weight and the duration of stretch, respectively. The mean LES relaxation in all animals was 77.7 +/- 4.7%. The required weight to induce maximal LES relaxation differed in animals (714 +/- 348 g). N(G)-nitro-L-arginine, a nitric oxide inhibitor, blocked the axial stretch-induced LES relaxation almost completely (from 78 to 19%). Our data support the presence of an axial stretch-activated inhibitory mechanism in the LES. The role of axial stretch in the LES relaxation induced by swallow and esophageal distension requires further investigation. PMID:17023549

Dogan, Ibrahim; Bhargava, Valmik; Liu, Jianmin; Mittal, Ravinder K

2007-01-01

422

Lower esophageal sphincter relaxation reflex kinetics: effects of peristaltic reflexes and maturation in human premature neonates.  

PubMed

We defined the sensory-motor characteristics of the lower esophageal sphincter relaxation (LESR) (stimulus threshold volume, response onset, and relaxation period, relaxation magnitude, nadir) during maturation in human neonates. We hypothesized that LESR kinetics differs during maturation and with peristaltic reflex type. Basal and adaptive esophageal motility testing was performed (N = 20 premature neonates) at 34.7 and 39.1 wk (time 1 and time 2). Effects of midesophageal provocation with graded stimuli (N = 1,267 stimuli, air and liquids) on LESR kinetics during esophagodeglutition response (EDR) and secondary peristalsis (SP) were analyzed by mixed models. Frequency of LESR with basal primary peristalsis were different during maturation (P = 0.03). During adaptive responses with maturation, 1) the frequencies of peristaltic reflexes and LESR were similar; 2) liquid stimuli resulted in a shorter LESR response latency and LESR nadir and greater LESR magnitude (all P < 0.05); 3) media differences were noted with LESR response latency (air vs. liquids, P < 0.02); and 4) infusion flow rate-LESR were different (P < 0.01 for air and liquids). Mechanistically, 1) frequency of LESR was greater during peristaltic reflexes at both times (vs. none, P < 0.0001); 2) LESR response latency, duration, and time to complete LESR were longer with EDR (all P < 0.05, vs. SP at time 2); and 3) graded stimulus volume LESR were different for air and liquids (P < 0.01). In conclusion, sensory-motor characteristics of LESR depend on the mechanosensitive properties of the stimulus (media, volume, flow), type of peristaltic reflex, and postnatal maturation. Maturation modulates an increased recruitment of inhibitory pathways that favor LESR. PMID:20864655

Pena, Eneysis M; Parks, Vanessa N; Peng, Juan; Fernandez, Soledad A; Di Lorenzo, Carlo; Shaker, Reza; Jadcherla, Sudarshan R

2010-12-01

423

Lower esophageal sphincter relaxation reflex kinetics: effects of peristaltic reflexes and maturation in human premature neonates  

PubMed Central

We defined the sensory-motor characteristics of the lower esophageal sphincter relaxation (LESR) (stimulus threshold volume, response onset, and relaxation period, relaxation magnitude, nadir) during maturation in human neonates. We hypothesized that LESR kinetics differs during maturation and with peristaltic reflex type. Basal and adaptive esophageal motility testing was performed (N = 20 premature neonates) at 34.7 and 39.1 wk (time 1 and time 2). Effects of midesophageal provocation with graded stimuli (N = 1,267 stimuli, air and liquids) on LESR kinetics during esophagodeglutition response (EDR) and secondary peristalsis (SP) were analyzed by mixed models. Frequency of LESR with basal primary peristalsis were different during maturation (P = 0.03). During adaptive responses with maturation, 1) the frequencies of peristaltic reflexes and LESR were similar; 2) liquid stimuli resulted in a shorter LESR response latency and LESR nadir and greater LESR magnitude (all P < 0.05); 3) media differences were noted with LESR response latency (air vs. liquids, P < 0.02); and 4) infusion flow rate-LESR were different (P < 0.01 for air and liquids). Mechanistically, 1) frequency of LESR was greater during peristaltic reflexes at both times (vs. none, P < 0.0001); 2) LESR response latency, duration, and time to complete LESR were longer with EDR (all P < 0.05, vs. SP at time 2); and 3) graded stimulus volume LESR were different for air and liquids (P < 0.01). In conclusion, sensory-motor characteristics of LESR depend on the mechanosensitive properties of the stimulus (media, volume, flow), type of peristaltic reflex, and postnatal maturation. Maturation modulates an increased recruitment of inhibitory pathways that favor LESR.

Pena, Eneysis M.; Parks, Vanessa N.; Peng, Juan; Fernandez, Soledad A.; Di Lorenzo, Carlo; Shaker, Reza

2010-01-01

424

Quantitative Evaluation of Electrodes for External Urethral Sphincter Electromyography during Bladder-to-Urethral Guarding Reflex  

PubMed Central

Purpose Accuracy in the recording of external urethral sphincter (EUS) electromyography (EMG) is an important goal in the quantitative evaluation of urethral function. This study aim was to quantitatively compare electrode recordings taken during tonic activity and leak point pressure (LPP) testing. Methods Several electrodes, including the surface electrode (SE), concentric electrode (CE), and wire electrode (WE), were placed on the EUS singly and simultaneously in six female Sprague-Dawley rats under urethane anesthesia. The bladder was filled via a retropubic catheter while LPP testing and EUS EMG recording were done. Quantitative baseline correction of the EUS EMG signal was performed to reduce baseline variation. Amplitude and frequency of one-second samples of the EUS EMG signal were measured before LPP (tonic activity) and during peak LPP activity. Results The SE, CE, and WE signals demonstrated tonic activity before LPP and an increase in activity during LPP, suggesting that the electrodes accurately recorded EUS activity during tonic activity and during the bladder-to-EUS guarding reflex, regardless of the size or location of detection areas. SE recordings required significantly less baseline correction than both CE and WE recordings. The activity in CE-recorded EMG was significantly higher than that of the SE and WE both in single and simultaneous recordings. Conclusions These electrodes may be suitable for testing EUS EMG activity. The SE signal had significantly less baseline variation and the CE detected local activity more sensitively than the other electrodes, which may provide insight into choosing an appropriate electrode for EUS EMG recording.

Steward, James E.; Clemons, Jessica D.; Zaszczurynski, Paul J.; Butler, Robert S.; Damaser, Margot S.; Jiang, Hai-Hong

2009-01-01

425

Gastric Emptying Function in Patients 5 Years After Pylorus-Preserving Distal Gastrectomy With or Without Preserving Pyloric and Hepatic Branches of the Vagal Nerve for Early Gastric Cancer  

Microsoft Academic Search

Background  To clarify the significance of preserving pyloric and hepatic branches of the vagal nerve (PHV) after pylorus preserving distal\\u000a gastrectomy (PPG) for early gastric cancer, the author investigated the postgastrectomy syndrome and gastric emptying function\\u000a at 5 years in PPG patients with or without preserving the PHV.\\u000a \\u000a \\u000a \\u000a Methods  A total of 18 subjects (mucosal cancers) who underwent PPG with D1 lymph node

Ryouichi Tomita

2009-01-01

426

Cognitive Dysfunction in Multiple Sclerosis  

PubMed Central

In Multiple Sclerosis (MS) prevalence studies of community and clinical samples, indicate that 45–60% of patients are cognitively impaired. These cognitive dysfunctions have been traditionally described as heterogeneous, but more recent studies suggest that there is a specific pattern of MS-related cognitive dysfunctions. With the advent of disease-modifying medications for MS and emphasis on early intervention and treatment, detection of cognitive impairment at its earliest stage becomes particularly important. In this review the authors address: the cognitive domains most commonly impaired in MS (memory, attention, executive functions, speed of information processing, and visual–spatial abilities); the pathophysiological mechanism implied in MS cognitive dysfunction and correlated brain MRI features; the importance of neuropsychological assessment of MS patients in different stages of the disease and the influence of its course on cognitive performance; the most used tests and batteries for neuropsychological assessment; therapeutic strategies to improve cognitive abilities.

Guimaraes, Joana; Sa, Maria Jose

2012-01-01

427

[Sexual dysfunction after radical prostatectomy].  

PubMed

Erectile dysfunction is not the only sexual dysfunction that impact quality of life of patients following radical prostatectomy for prostate cancer. Patients must be informed about these consequences and also about the prevention and treatment modalities that could be proposed after surgery. Preoperative erectile function and couple motivation are predictive of the quality of the sexual relationship after radical prostatectomy. A preoperative erectile dysfunction must be investigated as well as if it was the main symptom (evaluation of comorbidities, cardiovascular and psychological risk factors). The quality of the preservation of the neurovascular bundles is the other main determinant that must be decided according to cancer characteristics and performed according to a mastered surgical technic. PMID:20123513

Wagner, L; Faix, A; Cuzin, B; Droupy, S

2009-12-01

428

Manometric evaluation of internal anal sphincter after fissurectomy and anoplasty for chronic anal fissure: a prospective study.  

PubMed

Chronic anal fissure (CAF) is a common painful clinical disease and its pathogenesis remains poorly understood. After failure of pharmacological therapy, that is the first-line treatment, surgical sphincterotomy remains the treatment of choice although it is followed by a high rate of anal incontinence resulting from the sphincter damage; therefore, the research of a sphincter-saving surgical option has become an important goal. The aim of this study was to evaluate the manometric modifications and the incidence of anal incontinence after fissurectomy and anoplasty with advancement skin flap in patients affected by CAF with hypertonia of the internal anal sphincter (IAS). Fifteen patients affected by CAF with hypertonia of IAS, unresponsive to medical therapy, were enrolled. All subjects underwent fissurectomy and anoplasty with advancement skin flap. Anorectal manometry was performed preoperatively and after 6 and 12 months from surgery. Maximum resting pressure (MRP), maximum squeeze pressure (MSP), ultraslow wave activity (USWA), fissure healing, anal continence, and postoperative complications were recorded. All patients healed within 30 days from surgery. No intra- or postoperative complications were recorded except for a case of partial donor site break. No significant modifications of MSP were detected. Six months after surgery, MRP was higher with respect to healthy subjects but significantly reduced in comparison to baseline levels. At 12 months, it was higher have versus 6-month values but significantly lower versus preoperative values. USWA was significantly represented in patients with CAF versus healthy subject. Both at 6 and 12 months, they decreased significantly with respect to preoperative values without significant differences versus healthy subjects. Both at 6 and 12 months, anal continence did not differ with respect to preoperative time. The fissurectomy with anoplasty resulted in a high healing rate without surgical sequelae or anal incontinence. Also, it was able to reduce IAS pressure in the same manner as surgical sphincterotomy or forceful dilatation. PMID:22546122

Patti, Rosalia; Territo, Valentina; Aiello, Paolo; Angelo, Giuseppe Livio; Di Vita, Gaetano

2012-05-01